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The publication of the fourth edition of Health for All Children (Hall 4) in 2003 marked a shift in health visiting towards a more targeted service. This paper aims to explore, through the accounts of health visitors, the impacts of this changed policy context for health visiting practice and for the health visiting profession. The study, upon which this paper is based, was a qualitative exploration carried out in one NHS locality with broad socio-economic diversity. Semi-structured interviews were undertaken with 16 health visitors. The data was analysed using thematic and narrative techniques. In the study health visitors expressed concerns about the impacts of Hall 4 on health visiting practice, particularly in relation to health visiting expertise and the increase focus on child protection work shaping health visiting practice. In conjunction, health visitors' accounts suggest low morale as a profession. The paper concludes that the impacts of future policy change on health visiting practice must be fully considered; and, measures taken to prepare and support health visitors through periods of policy change. [ABSTRACT FROM AUTHOR]

This paper focuses on the role of 'social support' in the experience of fibromyalgia (a musculoskeletal pain disorder) in South Africa. In-depth semi-structured interviews were used to collect narratives from 15 participants. Sources of social support constitute important mechanisms for coping with the illness experience of fibromyalgia. In providing a space for consultation and validation of the diagnosis of fibromyalgia, and the person living with the condition, people giving support fulfil a critical role in shaping the experience. The findings show how support from family, partners, and peers plays an integral role in the process of accepting fibromyalgia diagnosis, adapting to the demands of the condition, and seeking help from healthcare providers. The findings also show the ways in which people with fibromyalgia provide support for others with the condition, and the importance of this peer network in shaping the paths and outcomes of this illness experience. The findings of this study corroborate existing evidence that show fibromyalgia to be a complex condition to manage, due to the multiplicity, uncertainty and contestation that feature in the experience of the illness. Additionally, this study presents the challenges related to the limitations of access to healthcare in the South African context, and the utility of narrative approaches in garnering insight into the ways in which social support is harnessed in this environment. [ABSTRACT FROM AUTHOR]

An increasing number of migrant social workers are employed in the UK social work sector. This article explores the acculturative integration experiences of a small group of migrant social workers. We critically observe that research on migrant professionals' trajectories should adopt theories that emphasise people's empowerment and potential for agency. We use a framework drawing on liberation psychology for analysing the autobiographical narratives of a sample of migrant social workers employed in England. Findings indicate that the participants perceived prejudice on a number of occasions and circumstances. Even though in their narrative of survival they talked about activating several psychosocial resources, they were skeptical about their professional development and dissatisfied at work. The paper discusses the emerging findings while highlighting the framework's relevance for understanding these experiences from an empowering acculturation perspective and suggesting ways of improving migrant social workers' acculturative integration by addressing systemic barriers. [ABSTRACT FROM AUTHOR]

Objective. The Australian Dental Council is responsible for the assessment of overseas-qualified dentists seeking to practice dentistry in Australia. The aim of this paper is to reflect on the Council's assessment and examination process through the experiences and perceptions of overseas-qualified dentists in Australia. Methods. Qualitative methods were used. Life stories of 49 overseas-qualified dentists from 22 nationalities were analysed to discern significant themes and patterns. We focused on their overall as well as specific experiences of various stages of the examination. The analysis was consistent with a hermeneutic phenomenological approach to social scientific research. Results. Most participants referred to 'cost' of the examination process in terms of lost income, expenses and time. The examination itself was perceived as a tough assessment process. Some participants seemed to recognise the need for a strenuous assessment due to differences in patient management systems in Australia compared with their own country. Significantly, most of the participants stressed the importance of support structures for overseas-qualified dentists involved in or planning to undertake the examination. These considerations about the examination experience were brought together in two themes: (1) 'a tough stressful examination'; and (2) 'need for support.' Conclusion. This paper highlights the importance of support structures for overseas-qualified dentists. Appropriate support (improved information on the examination process, direction for preparation and training, further counselling advice) by recognised bodies may prevent potential exploitation of overseas-qualified dentists. Avenues that have been successful in providing necessary support, such as public sector schemes, offer policy options for limited recruitment of overseas-qualified dentists in Areas of Need locations. Such policies should also be in line with the local concerns and do not reduce opportunities for Australian-qualified dentists. [ABSTRACT FROM AUTHOR]

Dignity is a universally important issue for all people, and particularly vital for older adults who face multiple losses associated with ageing. In the United States of America and beyond, the maintenance of dignity is a key aim of policy and service provision for older people. Yet surprisingly little research has been conducted into the meaning of dignity to community-based older adults in the context of everyday life. As life expectancy continues to increase worldwide, unprecedented numbers of people are living longer than ever before. The majority of older adults will face declining health and other factors that may impact dignity in the course of ageing in their communities. This paper reports on a study that explored older people's understandings and experiences of dignity through focus groups and a survey. Three key components of dignity are identified: autonomy, relational and self-identity. In addition, the paper discusses a range of factors that can facilitate or inhibit a sense of dignity for older people, including long-term health issues, sensory deficits and resilience to life events. Finally, the implications of these findings for policy and practice are considered in the context of American social structures and values. [ABSTRACT FROM PUBLISHER]

Objective:In recent decades, psychiatric services have been challenged to be more responsive to patients’ coexisting problems, in particular those concerning substance use. In Australia this has been referred to as a “No Wrong Door” approach. This paper explores the meanings of this move for the acute mental health sector, including attitudes toward a No Wrong Door approach to people with a dual diagnosis of mental illness and substance use disorder.  Methods:This qualitative study involved a review of the research literatures, analysis of policy documents, and interviews with 19 key informants in a case study of the State of Victoria, Australia.  Results:The analysis resulted in two broad themes surrounding the implications of dual diagnosis discourse for the mental health sector. The first involves progress regarding the concept of No Wrong Door with subthemes including interprofessional cultural conflicts, intersectoral professional status issues, terminology, problem definition, perspectives on serious mental illness, the role of the client, and pharmacological treatment. The second overarching theme focuses upon informants’ thoughts on future directions for the sector and highlights divided opinion on the implications of dual diagnosis discourse for the mental health service and social care systems.  Conclusions:While the perspectives on system change and multiple issues such as resource concerns and cultural clashes are presented here, the informants in this study also gave clear guidance for the future of dual diagnosis work in the mental health sector (e.g., focusing on orienting services toward consumer strengths and recovery), along with recommendations for future research. This paper contributes to the small body of qualitative research on the history and course of efforts to develop appropriate practice in mental health services with regard to patients who have substance use problems and other mental health disorders. [ABSTRACT FROM PUBLISHER]

Background: High rates of youth re‐offending indicate that young custody‐leavers face challenges when reintegrating into their communities. Aftercare and resettlement programs can occur pre‐, during, and post‐release and generally provide multiple forms of support services to address youths' transitional needs. Objectives: The present review examines (1) the impact of youth aftercare/resettlement programs on crime‐related outcomes, (2) how treatment effect is moderated by participant, program, and study characteristics, (3) whether some types of interventions are more effective than others, (4) barriers/facilitators to effective program implementation, (5) the theory of change underlying resettlement interventions, and (6) available research on intervention cost. Search Methods: A comprehensive set of keywords and synonyms was combined in a Boolean search across 26 electronic databases. Multiple gray literature sources were also searched, including 23 journals, 4 meeting archives, 11 organization websites, 3 open access journal websites, and the CVs of 8 well‐known researchers in the field. The search was completed in January 2023. Selection Criteria: For objectives 1–3, studies were included if they utilized a randomized controlled design or quasi‐experimental comparison group design in which participants were matched on at least some baseline variables and included at least one quantitative individual‐measure of crime. For objective 4, included studies presented process evaluations of aftercare/reentry programs, clearly stated their research goals, and used qualitative methods in an appropriate way to answer the stated research question. For objectives 5 and 6, no specific methods were required; any study meeting the criteria for objectives 1–4 which presented findings on theory of change or cost data were included. For all outcomes, only studies conducted in a westernized country, and published after 1991 in English, French, or German were considered. Data Collection and Analysis: Two coders conducted primary data extraction for the included studies. Data were entered into a Microsoft Excel database. After data extraction, the two coders validated the coding by cross‐checking the database with each research report. Discrepancies between coders were discussed until consensus was reached. Where consensus could not be reached, a third coder was consulted. Study risk of bias was addressed using the ROBINS‐I (Sterne et al., 2016), ROB‐2 (Higgins et al., 2019), and the critical appraisal skills programme (CASP, 2018). Objectives 1–3 were addressed by synthesizing quantitative outcomes from rigorous impact evaluations of aftercare interventions using random effects models and meta‐regression. Thematic and narrative analysis was conducted to address objectives 4–6. Results: The search resulted in 15 impact studies, representing 4,718 participants across 21 program sites, and 35 effect sizes. The 21 impact evaluations were rated as having either low/moderate bias (k = 11) or serious bias (k = 10). The synthesis of 15 impact studies found no significant effects for arrest (k = 14; OR = 1.044, 95% prediction interval [0.527, 2.075], t = 0.335) or incarceration (k = 8, OR = 0.806, 95% prediction interval [2.203, 1.433], t = −1.674). A significant pooled effect was found for conviction (k = 13, OR = 1.209, 95% prediction interval [1.000, 1.462], t = 2.256), but results were highly sensitive to the inclusion of specific studies. No meaningful pattern of results emerged in moderator analyses with respect to study, sample, program component, or program delivery characteristics. The 19 process studies were rated as either high quality (k = 12) or moderate quality (k = 7). Thematic synthesis of the process evaluations revealed 15 themes related to the strengths/challenges of program implementation. The assessment of program cost (k = 7) determined a lack of data within the literature, preventing any summative analysis. Authors' Conclusions: Current evidence is promising with respect to conviction outcomes but overall does not find that aftercare/resettlement interventions have a reliably positive impact on crime‐related outcomes for young people who have offended. High variability across outcomes and reported data resulted in small sample sizes per outcome and limited moderator analyses. Multiple challenges for program implementation exist; additional rigorous research is sorely needed to further investigate the nuances of the program effects. [ABSTRACT FROM AUTHOR]

Over the past two decades there has been a growing awareness that sport may not be a positive experience for all children. For example, we know that some children experience sexual abuse in the context of organised sport, and that these offences are often committed by trusted adults, including coaches and club officials. However, less attention has been given to the physical abuse of child athletes. This paper presents a study that explored children's experiences of organised sport, as recounted by young people between the ages of 18 and 25 years in Australia. The study explored the experience of child physical abuse in organised sport including violence, overtraining, and training while injured. A mixed methods research design produced 107 survey responses and 10 in-depth interviews with young adults. Most respondents reported the positive impact that participating in sport had had on their development, but more than a third of the respondents also described experiences of overtraining, being forced to train when injured or of direct physical violence. Drawing upon a thematic analysis of the qualitative data, a conceptual model has been developed and is presented to assist in the understanding of the dynamic of secrecy, which may facilitate ongoing physical harm to children in this context. [ABSTRACT FROM AUTHOR]

Objective The aim of this paper was to examine sexual knowledge, concerns and needs of youth with spina bifida (SB) to inform the medical community on ways to better support their sexual health. Methods As part of the Video Intervention/Prevention Assessment (VIA) - transitions, a prospective cohort study, 309 h of video data were collected from 14 participants (13-28 years old) with SB. Participants were loaned a video camcorder for 8-12 weeks to shoot visual narratives about any aspects of their lives. V/A visual narratives were analysed with grounded theory using NVivo. Results Out of 14 participants, 11 (six women) addressed issues surrounding romantic relationships and sexuality in their video clips. Analysis revealed shared concerns, questions and challenges regarding sexuality gathered under four main themes: romantic relationships, sexuality, fertility and parenthood, and need for more talk on sexuality. Conclusions Youth with SB reported difficulties in finding answers to questions regarding their sexuality, romantic relationships and fertility. This study revealed a need for help from the medical community to inform and empower youth with SB in the area of sexual health. Through sexual and reproductive health education with patients and parents starting at an early age, medical providers can further encourage healthy emotional and physical development in adolescents transitioning into adulthood. [ABSTRACT FROM AUTHOR]

While much research has documented unsatisfactory sexual and reproductive health (SRH) awareness among young people in South Africa, understanding of gender differences in access to and evaluation of SRH information is limited. This paper concerned itself with men and women's informal sources and content of SRH, and gendered divergences around accessibility, evaluation, and impact of such information. Fifty sexual history narrative interviews and twenty-five narrative interviews with women were conducted with participants purposively sampled from a range of ages, cultural and racial backgrounds, and in urban and rural sites across five provinces in South Africa. Data were analysed using thematic analysis. While young women were more likely to learn about SRH information from family members, they also reported greater regulation concerning their sexuality. This could enhance stigma surrounding women's sexuality and hinder open communication. Men predominantly learned about sex through pornography and peers, which was reported to encourage sexual prowess to the neglect of practising safer sex. Lack of adequate SRH instruction for young people as revealed through the narratives had significant and often negative implications for men and women's early safer sex behaviours. In response to these insights, recommendations are offered to strengthen informal sources of SRH awareness. [ABSTRACT FROM AUTHOR]

Background: South Africa uses government-funded return-of-service (RoS) schemes to train, recruit and retain skilled health professionals in underserved areas. These educate health professionals locally or internationally in return for a commitment to serve in a specified area for an agreed period. While such schemes are used widely and are funded by substantial public funds, their exact makeup differs across jurisdictions, and little is known about why these differences have emerged or how they influence their effectiveness or impact on the health system. We aimed to fill these gaps through an analysis of the origins, architecture, and evolution of RoS schemes in South Africa. Methods: A multimethod research study including a policy review, a literature review, and semi-structured interviews of policymakers was undertaken between October 2020 and August 2022. The included policy documents and literature were analysed using the Walt and Gilson framework and narrative synthesis. Qualitative data were analysed using inductive, thematic analysis in NVIVO 12. Results: RoS schemes are used as a recruitment and retention strategy and a mechanism to address equity in access to medical education. Whilst there is evidence of RoS schemes existing in 1950, no evidence of beneficiaries was found in databases until 1989. The impact of these schemes is likely being limited by sub-optimal institutional arrangements and poor transparency in their design and implementation. Conclusion: Despite rigorous research methods, the origins of RoS policies in South Africa could not be established due to poor preservation of institutional memory. Opportunities to monitor the value of public investment into RoS programs are being missed and often the underlying objective of the programs has not been well-specified. Policies were found to have been developed and operate in isolation from other health workforce planning activities and thus may not be maximising their impact as a retention and training tool. [ABSTRACT FROM AUTHOR]

Most of the literature on paediatric oncology treatment has provided descriptions of children's everyday lives that are circumscribed to periods of hospitalisation. In this paper, I argue that the political and economic context where children receive oncology treatment as well as the particular trajectories of their families influence their experiences. The narratives from children receiving treatment in three public hospitals in Buenos Aires, Argentina, were collected. Their stories indicate that issues such as the interruption of school, the separation of family members, the expenses incurred during treatment, and barriers to care influence the everyday lives of children and should be included in paediatric oncology research. © 2011 The Author(s). Children & Society © 2011 National Children's Bureau and Blackwell Publishing Limited [ABSTRACT FROM AUTHOR]

Purpose: This study aims to explore the coping styles that can be inferred from the discourse of dyads with dementia, and how these appear to impact on care management. Design/methodology/approach: This was a case study approach. Participants were recruited from two teams managing crisis in dementia in the UK. The authors conducted multiple qualitative interviews with people with dementia and their family carers over the course of one month. The analysis was first performed through thematic analysis. Data were further analysed through narrative inquiry to create a story line, or play in our case, for our findings. Findings: Five dyads were interviewed and a total of 16 interviews were conducted. Three dyads were husband–wife and two were daughter–mother relationships. The mean age was 67.4 years for carers and 79.8 years for people with dementia. In these cases, the carer assumed responsibility for managing the episode and was more likely to seek formal help if a pre-existing plan was in place. Otherwise, when a crisis arose, dyads preferred to avoid involving professionals. Practical implications: Psychosocial interventions should aim to identify and replace unhelpful strategies used by dyads to manage crisis episodes. Originality/value: To the best of the authors' knowledge, this is the first study using qualitative interviews of dyads to inquire into their experience of mental health crisis. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Intimate partner violence (IPV) during pregnancy is associated with maternal and infant health. However, in South Africa, where 20% to 35% of pregnant women report experiencing IPV, antenatal care rarely addresses violence. Little research has explored how clinic staff, community members, or pregnant women themselves view IPV. We conducted formative, qualitative research with 48 participants in urban Johannesburg. Focus group discussions with pregnant women (n = 13) alongside qualitative interviews with health providers (n = 10), managers and researchers (n = 10), non-governmental organizations (n = 6), community leaders (n = 4), and pregnant abused women (n = 5) explored the context of IPV and health care response. Data were analyzed using a team approach to thematic coding in NVivo 10. We found that pregnant women in the urban Johannesburg setting experience multiple forms of IPV, but tend not to disclose violence to antenatal care providers. Providers are alert to physical injuries or severe outcomes from IPV, but miss subtler cues, such as emotional distress or signs of poor mental health. Providers are uncertain how to respond to IPV, and noted few existing tools, training, or referral systems. Nevertheless, providers were supportive of addressing IPV, as they noted this as a common condition in this setting. Providers and managers considered the safety and well-being of mother and infant to be a strong rationale for the identification of IPV. Pregnant women were receptive to being asked about violence in a kind and confidential way. Understaffing, insufficient training, and poorly developed referral systems were noted as important health system problems to address in future interventions. South African patients and providers are receptive to the identification of and response to IPV in antenatal care, but require tools and training to be able to safely address violence in the health care setting. Future interventions should consider the urban South African antenatal clinic a supportive, if under-resourced, entry point for improving the health of pregnant women experiencing violence. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore service provision for Victorian regional refugee families from the perspective of maternal and child health nurses. Background: Increasingly, more families from a refugee background are resettling in regional Victoria. The refugee journey has significant effect on families. Refugee families with infants and young children can be provided with support by maternal and child health services; however, many families experience barriers to ongoing engagement with this service. Design: This descriptive study used focus group and questionnaire. A purposive sample of 26 maternal and child health nurses was drawn from six municipalities throughout regional Victoria, where higher numbers of people from a refugee background resettle. Six focus groups were held in 2014. Audio‐recorded narratives were transcribed, prior to inductive thematic analysis. Methods: This descriptive study used focus group and questionnaire. A purposive sample of 26 Maternal and Child Health nurses was drawn from six municipalities throughout regional Victoria where higher numbers of people from a refugee background resettle. Six focus groups were held in 2014. Audio‐recorded narratives were transcribed verbatim, prior to inductive thematic analysis. Results: Participating nurses were experienced nurses, averaging 12 years in the service. Four major themes emerged from thematic analysis: “How to identify women from a refugee background”; “The Maternal and Child Health nurse role when working with families from a refugee background”; “Interpreting issues”; and “Access to other referral agencies.” Nurses worked to develop a relationship with families, attending to a complex mix of issues which were complicated by language barriers. Nurses found their role in supporting refugee families required additional time and more home visits. Conclusions: To provide best practice, maternal and child health nurses need (i) ongoing professional development; (ii) time, flexibility and creativity to build relationships with refugee families and (iii) better access to services that enhance communication, such as interpreting services and translated resources. Relevance to clinical practice: Nurses require ongoing professional development to help them address the multifaceted needs of families of refugee background. With limited resources available in regional areas, accessing further education can be challenging. Distance education models and organisational support could provide nurses with educational opportunities aimed at improving service provision and clinical practice. [ABSTRACT FROM AUTHOR]

Aim: To explore Registered Nurses' attitudes and behaviour towards patients' use of complementary therapies. Background: Despite high rates of use of complementary therapies by the general population, little is known of how nurses respond to patients' use of these therapies. Design: A two-phase sequential exploratory mixed methods design. Methods: Nineteen Registered Nurses working in Australia participated in a semi-structured interview in 2015-2016 and emerging themes informed the development of a quantitative survey instrument administered online nationwide in 2016. Findings: Emerging key themes "Promoting safe care"; "Seeking complementary therapies knowledge";" Supporting holistic health care"; and "Integrating complementary therapies in practice" were reflected in survey results. Survey responses (N = 614) revealed >90% agreement that complementary therapies align with a holistic view of health and that patients have the right to use them. Most nurses (77.5%) discussed complementary therapies with patients and 91.8% believed nurses should have some understanding of the area. One-third did not recommend complementary therapies and there was a lack of overall consensus as to whether these therapies should be integrated into nursing practice. Nurses with training in complementary therapies held more positive views than those without. Conclusion: Nurses were generally supportive of patients' interest in complementary therapies, although their primary concern was safety of the patient. Despite broad acceptance that nurses should have a basic understanding of complementary therapies, there was a lack of consensus about recommendation, integration into nursing practice and referral. Further research should explore how nurses can maintain safe, patient-centred care in the evolving pluralistic healthcare system. [ABSTRACT FROM AUTHOR]

Background: The Danish public healthcare system provides comprehensive care based on the principle of equal access. However, it is well documented that patients with low socioeconomic position are less likely to participate in cardiac rehabilitation. More knowledge is needed to understand this phenomenon. The aim of the study was to explore the patient experience of barriers to completion of phase II cardiac rehabilitation, and to investigate the impact of socioeconomic factors on completion of cardiac rehabilitation. Methods: The study had a qualitative explorative design using semi-structured individual or dyadic interviews with patients (n = 24) and close relatives (n = 12). Informants were sampled from a quantitative prospective study of 302 patients with acute coronary syndrome and data were analyzed using the framework method. Results: Patients in different socioeconomic groups were challenged by a rigid and non-individualized rehabilitation program. A total of five themes were identified that might explain non-participation in cardiac rehabilitation: exclusion by time and place, exclusion by health beliefs, exclusion from counseling, exclusion by alienation, and exclusion of relatives. The themes were described in a matrix of socioeconomic factors of age, sex, education and employment. Conclusions: Patients in various socioeconomic subgroups felt excluded from cardiac rehabilitation for different reasons. This study supports earlier findings and provides examples of real-life issues that need to be addressed to prevent attrition and encourage participation. Equal access to cardiac rehabilitation can only be reached if the physical and psychological needs of patient and family are met by tailoring therapy to consider age, sex, education and employment groups. [ABSTRACT FROM AUTHOR]

There is growing attention to the training and education of Personal Support Workers, or PSWs, who work in community, home and longterm care settings supporting older people and people with disabilities. In Ontario, Canada, amid a volatile policy landscape, the provincial government launched an effort to standardise PSW education. Using qualitative methods, this study considered the question: What are the central educational issues reflected by students, working PSWs and key informants, and are they addressed by the PSW programme and training standards? Phase one was a public domain analysis completed between January and March 2014 and updated for major developments after that period. Phase two, completed between August 2014 and March 2015, included 15 key informant interviews and focus group discussions and mini-phone interviews with 35 working PSWs and current PSW students. According to the participants, the central educational issues are: casualisation of labour that is not conveyed in educational recruitment efforts, disconnect between theory and working conditions, overemphasis on long-term care as a career path, and variability of PSW education options. While the standards should help to address the final issue, they do not address the other key issues raised, which have to do with the structural organisation of work. There is thus a disconnect between the experiences of students, PSWs and key informants and the policy decisions surrounding this sector. This is particularly significant as education is often touted as a panacea for issues in long-term and community care. In fact, the curriculum of some of the PSW programmes, especially those in public college settings, is robust. Yet, the underlying issues will remain barring a structural overhaul of the organisation of long-term and community care sectors founded on a social revaluing of older people and the gendered work of care. [ABSTRACT FROM AUTHOR]

Social rejection of drug use is greater than that directed at other psychiatric conditions, like depression and anxiety, which may lead to social exclusion of substance users and prevent them from seeking and receiving treatment. Objective: The objective of this study is to investigate the stigma and discrimination related to addiction in treatment centers in Mexico City. Methods: Data are from a broad mixed methods study. The present study is a qualitative analysis of 35 in-depth interviews of drug users, family members, and providers, using guidelines for the exploration of experiences of stigma and discrimination related to substance abuse. A thematic analysis was carried out using specialized software (Atlas.ti 6.2.23). Results: The common practices of stigma and discrimination (e.g., judging, mockery, inappropriate comments, overprotection, and hostile looks), were identified in participant testimonies. The narratives provide evidence of varied conditions of social and gender inequality, as well as experience of violence and abuse, that refer to a structural context of discrimination surrounding addiction, and that constitute obstacles to treatment. Conclusions: The findings allow for a description of the stigmatization process surrounding addiction as a shared problem that requires the implementation of coordinated treatment strategies. They also suggest the need for more comprehensive policies of inclusion, based on human rights, which favor prevention and treatment. [ABSTRACT FROM AUTHOR]

Objective: We examined cognitive and behavioural challenges and adaptations for people with progressive multiple sclerosis (MS) and developed a preliminary conceptual model of changes in adjustment over time. Design: Using theoretical sampling, 34 semi-structured interviews were conducted with people with MS. Participants were between 41 and 77 years of age. Thirteen were diagnosed with primary progressive MS and 21 with secondary progressive MS. Data were analysed using a grounded theory approach. Results: Participants described initially bracketing the illness off and carrying on their usual activities but this became problematic as the condition progressed and they employed different adjustment modes to cope with increased disabilities. Some scaled back their activities to live a more comfortable life, others identified new activities or adapted old ones, whereas at times, people disengaged from the adjustment process altogether and resigned to their condition. Relationships with partners, emotional reactions, environment and perception of the environment influenced adjustment, while people were often flexible and shifted among modes. Conclusions: Adjusting to a progressive condition is a fluid process. Future interventions can be tailored to address modifiable factors at different stages of the condition and may involve addressing emotional reactions concealing/ revealing the condition and perceptions of the environment. [ABSTRACT FROM AUTHOR]

Aim To explore the challenges of conducting research on sexuality and intimacy among older care home residents. Background Sexuality and intimacy are neglected in care policies and practices. Design Qualitative analytical study drawing on poststructuralist theorizing. Methods Semi-structured interviews were conducted with residents and spouses ( n = 6) and care staff ( n = 16) in two care homes in Northwest England in 2014. The sample was obtained through a network of 'research-ready' care homes. Thematic analysis was used to make sense of narratives with the aid of NVivo10. Results Participant responses highlight the workings of ageist erotophobic discourse that undergirds the assumption of residents (and old people generally) as postsexual. This materialized in reservations about the research ranging from opposition on moral grounds to doubts about its feasibility given the age-group concerned. However, residents and care home staff can also draw on counter-discourses that resist/challenge ageist erotophobic thinking, which materialized in methodological and ethical recommendations. Conclusion Participants generally agreed with the principle of the research and made recommendations that could counter/resist ageist erotophobic governance and guide researchers on sampling, style of questioning and communicating with (prospective) study participants on a sensitive subject. [ABSTRACT FROM AUTHOR]

Objective.To explore lay understandings of sickle cell disease (SCD) among Jamaicans living with the illness. There is no qualitative research on this subject in Jamaica, where SCD is the most common genetic disorder. Design.Thirty in-depth semi-structured interviews (50% males, 50% urban residence) were conducted with adult patients attending the Sickle Cell Unit in Jamaica. Transcribed data were analysed using thematic analysis. Results.Patients' narratives focused on two main themes: lay understandings of how SCD works (using ideas of attack and fortification, and blockage and flow); and what causes the illness (lay ideas of inheritance). The most common description of SCD was that their white blood cells were ‘eating/sucking out/feeding on’ their red blood cells. Hence, treatment required ‘building up’ their blood, while a key to good health was ensuring an unimpeded flow of blood. Most participants believed SCD was hereditary, but there were various understandings of the mechanism and probability of its transmission. Belief in the possibility of transmitting SCD was not always a barrier to reproduction, nor did participants always insist on their partner or child being tested. Conclusions.Participants engaged in medical pluralism, a dynamic combination of folk and biomedical beliefs. Their concerns, experiences and interpretations were powerful motivators of reproductive and screening behaviour. Their narratives of SCD transcend the individual to express social, societal and cultural realities. Health care professionals and policy-makers should communicate clearly to ensure understanding, and recognize and engage with their patients’ sociocultural context. [ABSTRACT FROM PUBLISHER]

Copyright of Family Process is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims and objectives To describe patients' experiences from symptom onset to initial treatment for atrial fibrillation. Background The estimated number of individuals with atrial fibrillation globally in 2010 was 33·5 million. World-wide, each year, new cases of atrial fibrillation approach 5 million, and prevalence will increase 2·5-fold by 2050. As a result, clinicians worldwide will treat a growing number of patients with atrial fibrillation. Early intervention to promote atrial fibrillation self-management is critical to reduce associated complications of stroke and heart failure. Greater understanding of patients' experiences from symptom onset to initial treatment for atrial fibrillation is needed to guide development of interventions to promote early effective self-management. Design A descriptive qualitative design was used. Methods Twenty females and 21 males at an academic medical centre were interviewed using open-ended questions to explore their experiences from symptom onset to initial treatment for atrial fibrillation. Data were analysed using qualitative content analysis. Results Participants' mean age was 64·3 (SD = 10·1) years. Four themes were identified: (1) misinterpreting symptoms; (2) discovering the meaning of atrial fibrillation; (3) facing fears, uncertainty, and moving to acceptance; and (4) receiving validation and reassurance. Participants lacked knowledge of atrial fibrillation and took cues from providers' responses to appraise symptoms and diagnosis. Fear and uncertainty were reduced when providers initiated prompt treatment and took time to explain atrial fibrillation. Patients appreciated receiving clear information about atrial fibrillation, were engaged in learning, and motivated to participate in their care. Conclusions Providers played a critical role in helping patients to develop an accurate understanding of atrial fibrillation, to cope with the new diagnosis, and motivated them to engage in effective self-management. Relevance to clinical practice Insight into participant experiences from symptom onset to initial treatment for atrial fibrillation may inform development of interventions to promote effective atrial fibrillation self-management. [ABSTRACT FROM AUTHOR]

Aim To provide depth and breadth in the analysis of nursing students' written narratives of 'most memorable' professionalism dilemmas. Background While nursing students are taught professionalism through formal curricula, they commonly experience workplace-based professionalism dilemmas. Although non-UK studies have begun to explore students' lived experiences of dilemmas, they lack detail about when and where dilemmas occur, who is involved, what students do and why and how students feel. Design Online survey of healthcare students including 294 nursing students from 15 UK nursing schools. Method Nursing students provided a written narrative of their most memorable dilemma (December 2011-March 2012) as part of a survey examining the impact of professionalism dilemmas on moral distress. We conducted thematic and discourse analysis of all narratives and narrative analysis of one exemplar. Findings The most common themes were patient care dilemmas by healthcare personnel or students, student abuse and consent dilemmas. Of the dilemmas, 49·6% occurred over 6 months previously, 76·2% occurred in hospitals and 51·9% of perpetrators were nurses. 79·3% of students reported acting in the face of their dilemma. Of the narratives, 88·4% contained negative emotion talk and numerous significant relationships existed between types of emotion talk and dilemmas. Our narrative analysis demonstrates the impact of dilemma experiences through emotion talk and more subtle devices like metaphor. Conclusion Findings extend previous research with nursing and medical students. Nurse educators should help students construct emotionally coherent narratives to make sense of their experiences, actions and identities and to better prepare them for future professionalism dilemmas. [ABSTRACT FROM AUTHOR]

Little is known about recipients' views of their sperm donor. This study aimed to examine the possible transitions or consistencies in donor sperm recipients' (DSRs') view on the sperm donor over time. A longitudinal qualitative study of 19 Belgian heterosexual DSRs was undertaken. Interviews took place with both partners of the couple during pregnancy, at birth and 1.5-2 years after birth, and were analysed using a grounded theory approach. Recipients who intended to disclose exhibited a transition in their awareness of the donor from being of minimal importance to one who was increasingly seen as part of their family narrative. This was partly triggered by the offspring's life, remarks about resemblance and the socio-cultural context. The perceived position of the donor changed for most recipients from a threatening rival to a 'distractor'. This change was supported by the emerging father-child bond and the confidence that stemmed from it. These observations were applicable to those recipients who intended to disclose their donor conception; for those recipients who intended not to disclose, little or no transition was observed. This study describes and analyses the transitions and consistencies in recipients' views of the donor over different stages of the family life-cycle (pregnancy, birth, toddler stage) and could help the fertility clinics tailor their counselling to the specific stages of parenthood. [ABSTRACT FROM AUTHOR]

This study was designed to explore Taiwanese school students’ attitudes toward sexual relationships and premarital sex. This was an exploratory descriptive, qualitative study. Focus groups (N = 8) were conducted with 47 adolescents from three high schools in Taiwan. Transcripts were transcribed and thematically analyzed using Atlas V 5.0. Adolescent attitudes toward sexual relationships and premarital sexual behavior comprise the following three dimensions: (1) external incentives, (2) the developmental process, and (3) internal control. External incentives include the normalization of sexual behavior between peers, the desire to feel included in a group, parental influence, and media influence. The developmental process includes imagining the sexual experience and onset of sexual activity. Internal control includes the fear of pregnancy, the fear of parental rejection, and the fear of being judged. These findings can provide a reference for designing future sex education curricula and counseling programs for adolescents. [ABSTRACT FROM PUBLISHER]

Sexual minority men and transgender women are disproportionately affected by HIV in Guatemala. Innovative prevention strategies are urgently needed to address these disparities. While social network approaches are frequently used to reach sexual minorities, little is known about the unique network characteristics among sub-groups. We conducted in-depth qualitative interviews with 13 gay-identifying men, eight non-gay-identifying men who have sex with men (MSM) and eight transgender women in Guatemala City. Using narrative and thematic coding procedures, we identified distinct patterns in the size, composition, and overlap between social and sexual networks across groups. Gay-identifying men had the largest, most supportive social networks, predominantly comprising family. For both non-gay-identifying MSM and transgender women, friends and sex clients provided more support. Transgender women reported the smallest social networks, least social support, and the most discrimination. HIV prevention efforts should be tailored to the specific sexual minority population and engage with strong ties. [ABSTRACT FROM AUTHOR]

Unaccompanied refugee mothers—young mothers living in another country and separated from their parents—are, in research and migration policies, often defined in terms of four social categories: refugee, unaccompanied, adolescent and mother. In-depth interviews were conducted with twenty unaccompanied refugee mothers from different countries of origin and now living in Belgium to listen, first, to their feelings and experiences. These narratives revealed four central themes in the mothers' experiences (constrained and constraining daily living conditions, emotional challenges, connectedness and motherhood as a turning point), which appeared to be, in a second analysis, related to intersections between the four social categories. However, the intersectional analysis revealed large gaps between the mothers' and migration policies' interpretations of these categories: the mothers not only define the categories differently, but also set other priorities as they identify themselves first as mothers, while the policies prioritise their status as refugees. These findings, together with reflections on the value of adopting an intersectional perspective, lead to several recommendations for research, social work practices and migration policies. [ABSTRACT FROM PUBLISHER]

This qualitative study explores community resilience factors within an indigenous Sámi community in Northern Norway. Semistructured interviews were conducted with 22 informants, 12 females and 10 males, ranging in age from 13 to 19 years old, 12 of whom had reindeer husbandry affiliation. Data analysis used a modified grounded theory approach and narrative analysis. Interpretation of the data was based on ecological perspectives theory and the identification of possible community resilience factors including Sámi language competence, use of recreational and natural resources, and traditional ecological knowledge, such as reindeer husbandry related activities. These cultural factors appear to strengthen adolescents’ ethnic identity and pride, which in turn act as potential resilience mechanisms. Land was a significant arena for traditional practices and recreation. The majority of the youth reported support from relationships with extended godparents (fáddarat) and extended family (sohka) networks. The fáttar network was particularly strong among adolescents with reindeer husbandry affiliations. Native language competence and reindeer husbandry were key components in adolescent social networks. Interconnectedness among the community members and with the environment seemed to promote resilience and well-being. Two factors that excluded adolescents from full community membership and participation were being a nonnative Sámi language speaker and the absence of extended Sámi family networks. [ABSTRACT FROM AUTHOR]

Timely and appropriate care for children with autism spectrum conditions is affected by the interaction between healthcare professionals and parents. Despite the importance of the parent–professional partnership, there is a dearth of cultural-specific data on parent–professional partnership in the Chinese context. We conducted 10 in-depth life-history interviews with parents of children with autism spectrum conditions in Hong Kong who were diagnosed during preschool years. Using an interpretative phenomenological analytic method, five themes were constructed to represent the context of parent–professional partnership in Hong Kong along the pathway of seeking a diagnosis: (a) access to the assessment and diagnosis of autism spectrum conditions, (b) multiple procedures of assessment, (c) consultation prior to diagnosis and assessment, (d) communication of diagnosis and assessment result and (e) post-assessment isolation. Parental narratives highlight the important domains of parent–professional partnership and reflect the complexity of diagnosis and the lack of a cohesive system. For many parents, the assessment procedure was marred by a series of obstacles, which were further exacerbated by a poorly developed parent–professional partnership. Suggestions for parent–professional partnership development include establishing an evidence-based best practice guideline for Hong Kong, creating pre-assessment information workshops for parents to attend and equipping professionals with knowledge about autism spectrum conditions and enhanced communication skills. [ABSTRACT FROM PUBLISHER]

The Recovery-Oriented Decisions for Relatives' Support (REORDER) intervention is an innovative, manualized protocol utilizing shared decision-making principles with military veterans who have serious mental illnesses to promote recovery and encourage consideration of family involvement in care. This treatment study by Dixon et al. (2014) compared REORDER to enhanced treatment as usual in a randomized design. This qualitative sub-study sought to understand the nuances of the decision-making process of including family members through in-depth interviews with veterans who were randomized to REORDER. The qualitative themes support the willingness of the interviewed veterans who have previously not included family members to situate themselves at the center of their care and deliberate through facilitated conversation, the pros and cons of involving family. REORDER brings a fresh perspective to adapting recovery principles into family-based interventions. [ABSTRACT FROM AUTHOR]

Concern for the creep of surveillance and control into the everyday lives of citizens has revived contemporary debates over the politics of health promotion. We examined how political changes have impacted on the work of health promoters through qualitative research with individuals working in the health promotion sector. Interviews and focus groups were undertaken between January 2008 and March 2009. Caught in a neoliberally influenced drive to increase the efficiency of the health sector, health promotion in New Zealand has been subject to considerable changes in the funding and provision of services. Characterised by a growth in limited-term contracts with constrained budgets, health promoters have responded to fiscal limitations by pooling resources. We find that rather than being uncritical agents of the government’s health promotion agenda, health promoters often became advocates of the community’s agenda, occupying a ‘grey space’ where the demands of contracts create tension with their commitments to communities. Any portrayal of health promotion must acknowledge the contested nature of the spaces of governance health promoters occupy and resist reducing them to uncritical agents of the state. [ABSTRACT FROM PUBLISHER]

Background High rates of primary cesarean internationally continue to create decision dilemmas for women and practitioners about birth in subsequent pregnancies. This article explores values and expectations that guide women during decision making about the next birth after cesarean and identifies factors that influence consistency between women's choices and actual birth experiences. Methods Narrative analysis was used to identify key themes in decision-making experiences of women who were facing a choice about mode of birth after cesarean. A sample of 187 women provided qualitative data about their choices for birth at 36-38 weeks. At 6-8 weeks after the birth, 168 also wrote about their experiences of birth and the process of making the decision. Results Decision making about birth after cesarean was complex and difficult for many women; strong emotions were expressed as they weighed birth options. Fear and anxiety were articulated as women explained their choices and expectations. Avoidance of the previous cesarean experience, an expectation of a 'better' or 'faster' recovery, and issues around 'safety' for the baby were common reasons given for wanting either vaginal or cesarean birth. Practitioner preferences were influential and women's need for information about their options underpinned their confidence or certainty about their decision. Conclusions Strategies are needed to support practitioners to expand discussions beyond clinical algorithms about physical risks and benefits of birth options and to actively integrate women's values and preferences into decisions about birth. [ABSTRACT FROM AUTHOR]

Context Medical students encounter situations during workplace learning in which they witness or participate in something unprofessional (so-called professionalism dilemmas), sometimes having a negative emotional impact on them. Less is known about other health care students' experiences of professionalism dilemmas and the resulting emotional impact. Objectives To examine dental, nursing, pharmacy and physiotherapy students' narratives of professionalism dilemmas: the types of events they encounter ('whats') and the ways in which they narrate those events ('hows'). Methods A qualitative cross-sectional study. Sixty-nine health care students (29 dentistry, 13 nursing, 12 pharmacy, 15 physiotherapy) participated in group/individual narrative interviews. Data were analysed using framework analysis (examining the 'whats'), linguistic inquiry and word count software (examining the 'hows' by dilemma type and student group) and narrative analysis (bringing together 'whats' and 'hows'). Results In total, 226 personal incident narratives (104 dental, 34 nursing, 39 pharmacy and 49 physiotherapy) were coded. Framework analysis identified nine themes, including 'Theme 2: professionalism dilemmas', comprising five sub-themes: 'student abuse', 'patient safety and dignity breaches by health care professionals', 'patient safety and dignity breaches by students', 'whistleblowing and challenging' and 'consent'. Using Linguistic Inquiry and Word Count ( liwc) software, significant differences in negative emotion talk were found across student groups and dilemma types (e.g. more anger talk when narrating patient safety and dignity breaches by health care professionals than similar breaches by students). The narrative analysis illustrates how events are constructed and the emotional implications of assigning blame (an ethical dimension) resulting in emotional residue. Conclusion Professionalism dilemmas experienced by health care students, including issues concerning whistleblowing and challenging, have implications for interprofessional learning. By focusing on common professionalism issues at a conceptual level, health care students can share experiences through narratives. The role-playing of idealised actions (how students wish they had acted) can facilitate synergy between personal moral values and moral action enabling students to commit and re-commit to professionalism values together. [ABSTRACT FROM AUTHOR]

Clinical research on lesbian, gay, bisexual, transgendered, queer, questioning, intersex, asexual, or two-spirited (LGBTQ) persons with co-occurring conditions (substance abuse plus mental illness-CC) is sparse. This study examines the unique and specific treatment barriers, needs, and experiences of LGBTQ persons living with CC. A focus group was conducted with 10 LGBTQ behavioral health clients diagnosed with CC. Among the more prominent findings was the importance of revealing and incorporating one's sexual identity in the therapeutic environment. This finding was reinforced by participant endorsement of a more holistic, integrative approach to their situation. Results are discussed within the context of improving service delivery to this population as well as identifying areas for future research. [ABSTRACT FROM PUBLISHER]

Aim This article is a report on a case study that described and analysed the collaborative process among nurse practitioners and registered nurses in oncology outpatient settings to understand and improve collaborative practice among nurses. Background Changes in the health system have created new models of care delivery, such as collaborative nursing teams. This has resulted in the increased opportunity for enhanced collaboration among nurse practitioners and registered nurses. The study was guided by Corser's Model of Collaborative Nurse-Physician Interactions (1998). Design Embedded single case design with multiple units of analysis. Methods Qualitative data were collected in 2010 using direct participant observations and individual and joint (nurse dyads) interviews in four outpatient oncology settings at one hospital in Ontario, Canada. Findings Thematic analysis revealed four themes: (1) Together Time Fosters Collaboration; (2) Basic Skills: The Brickworks of Collaboration; (3) Road Blocks: Obstacles to Collaboration; and (4) Nurses' Attitudes towards their Collaborative Work. Conclusion Collaboration is a complex process that does not occur spontaneously. Collaboration requires nurses to not only work together but also spend time socially interacting away from the clinical setting. While nurses possess the conceptual knowledge of the meaning of collaboration, findings from this study showed that nurses struggle to understand how to collaborate in the practice setting. Strategies for improving nurse-nurse practitioner collaboration should include: the support and promotion of collaborative practice among nurses by hospital leadership and the development of institutional and organizational education programmes that would focus on creating innovative opportunities for nurses to learn about intraprofessional collaboration in the practice setting. [ABSTRACT FROM AUTHOR]

The drug 'Ecstasy' has been most commonly associated with raves, or electronic music dance events, and attributed with sexual disinhibition. In an ethnographic investigation of drug use among second-generation Southeast Asian youth in Northern California conducted in 2003, respondents described little use of or interest in using Ecstasy; yet in a second study, Ecstasy was the fourth most commonly used substance. This article investigates the social contexts for this change in use patterns. Respondents were second-generation Southeast Asian youths and young adults between the ages of 15 and 26 who were currently or recently drug-involved. We compared qualitative data from the two studies and found emerging patterns of meaning and context related to the observed change in use patterns. Ecstasy use among co-resident African American youth within the context of the local 'hyphy' hip-hop music subculture had influenced Southeast Asian youths' uptake of the drug, known as 'thizz.' Respondents referred to the effects of the drug as 'thizzin',' described as energizing, disinhibiting, numbing, and emotion enhancing. Reported consequences of 'thizzin'' included violence and aggression as well as fun, while sexual disinhibition was rarely mentioned. The meanings assigned to drugs, including the effects ascribed to them, may be relative to the social contexts within which users are exposed to and consume drugs. The findings indicate the susceptibility of youths to local trends in drug use, particularly associated with popular cultural movements and music. Second-generation youths may be particularly susceptible relative to the conditions of their immigration and processes of identity formation unique to them. [ABSTRACT FROM AUTHOR]