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Background:Research impact is at least partly generated through collaborative interactions, yet the associations between knowledge production and impact are far more complex than relatively simple linear models generally describe. Aims and objectives:In this case study, we focus on a community-university partnership and try to answer the question, ‘What are the conditions that facilitate or hinder successful collaborative interactions aimed towards solving a shared challenge between partners from different organisations?’ Methods:A set of four co-creation sessions with diverse stakeholders was organised with the aim of tackling the nuisance caused by youth in a specific deprived neighbourhood in Belgium. The sessions were video-recorded, transcribed verbatim, and analysed following a Grounded Theory (GT) approach to develop theoretical understandings of the process of knowledge production and research impact. Findings:Roles and mandates of individual stakeholder representatives determine (and hinder) their access to (confidential) information, but also their visibility and accessibility towards youth as end users. Achieving positive outcomes through collaboration was perceived by stakeholders as slowly evolving towards small successes, and was facilitated by being able to accept failure, working in a climate of trust, developing a shared identity, managing expectations, informally sharing information, and being able to connect with youth. Discussion and conclusions:We reflect on the importance of overcoming organisational asymmetries in collaborative interactions through installing feedback loops, and through the particular roles of boundary organisations, boundary objects, and practical tools that can help steer iterative collaborative interactions towards positive impact.

Summary Tobacco smoking uptake is still a major public health concern, especially among youngsters living in vulnerable situations. Finding optimal ways to engage youngsters in smoking prevention is important. Compared to traditional settings such as schools, social work settings providing sports-based and recreational activities (SR-settings) tend to reach and engage youngsters more. This study aimed to gain insight into the reasons for smoking uptake among youngsters living in vulnerable situations and the conditions through which SR-settings are potentially beneficial for smoking prevention initiatives. Data were collected in two SR-settings in Flanders, Belgium, by means of five focus group discussions and six individual interviews with youngsters (n = 38, mean age = 12.9 ± 2.61 years, 69.7% boys) and eight individual interviews with youth workers (n = 8, mean age = 27.5 ± 7.95 years, 87.5% men). A thematic analysis (TA) approach was applied to analyse the data. Besides individual factors, such as attitudes towards smoking, the desire to be part of a group and conformity to group norms seem to be important drivers of smoking uptake among youngsters in vulnerable situations. The presence of powerful role models in SR-settings with whom youngsters identify may counteract group norms by encouraging healthy behaviour. SR-settings seem suitable for questioning perceptions of vulnerable youngsters, unlike other settings where they may struggle to be heard. The conditional characteristics of SR-settings, such as authentic group processes, having meaningful roles, and being heard, make these contexts promising venues for smoking prevention efforts among vulnerable youngsters. Youth workers who have established trusting relationships with youngsters seem well-suited to communicate smoking prevention messages. A participatory approach, in which youngsters are involved in developing smoking prevention programs, is desirable.

BACKGROUND Improving healthy lifestyles may promote mental health in adolescents, and mobile health (mHealth) may be a valuable way to reach that objective. So far, no mobile healthy lifestyle intervention existed for promoting mental health in the general adolescent population. The mHealth intervention #LIFEGOALS was developed using a participatory approach, and combining behavior change techniques with a support chatbot and narrative videos as engagement-enhancing features. OBJECTIVE To evaluate the effectiveness of the mHealth intervention #LIFEGOALS for promoting mental health and health behaviors, and to identify its potential working mechanisms. METHODS A quasi-RCT with 12-week intervention period was followed by process evaluation interviews and took place in 2020-21 during the COVID-19 pandemic. Adolescents (12-15y) were allocated at school-level to the intervention group (receiving #LIFEGOALS app with activity tracker for self-monitoring) or control group (receiving no intervention). Health-related quality of life (HRQoL, KIDSCREEN-10) was measured via a web-based survey at baseline, after 6 weeks, and post-intervention. At baseline and post-measurement, psychological well-being, moods & emotions, self-perception, social support & peers, resilience, depressive symptoms, sleep quality and breakfast frequency were assessed via a web-based survey; and physical activity, sedentary time, and week-weekend sleep time difference via Axivity accelerometers. Multilevel generalized linear models were fitted to investigate intervention effects and moderation by pandemic-related measures. Individual interviews were conducted in a subsample (with above average app usage) of the intervention group. Themes aiding in the understanding of how the intervention led to change were identified using thematic analysis. RESULTS Out of 184 participants in the intervention group, 150 had used the app and were included in the analyses (total N=279, age=13.63±0.96 years, 55% girls). The mHealth intervention showed positive effects on moods & emotions for adolescents with full in-school education (χ2(1)=2.30, P=.02), but negative effects on HRQoL (χ2(2)=14.72, P CONCLUSIONS #LIFEGOALS showed mixed results on healthy lifestyle and mental health outcomes. The findings highlight the role of contextual factors for mHealth promotion in adolescence, and provide suggestions to optimize a support chatbot and narrative episodes within mHealth for improving adoption and effectiveness. CLINICALTRIAL ClinicalTrials.gov [NCT04719858]

Does 15-minute consult using Motivational Interviewing (MI) have a positive effect on (1) time until return to work (RTW) and relapse after work resumption for patients who have been work disabled for longer than 3 months, and (2) can psychological variables (i.e., work-related motivation, work-related psychological needs, quality of life and work ability) explain these results?265 patients were included in a pilot randomized controlled trial, parallel and single blind, with an allocation ratio of 1:1 comparing the consult with MI with the consult as usual group (CAU). There was a 12-month follow up on actual RTW and relapse for both groups. The psychological outcomes were work-related motivation (MAWS), work-related psychological needs (BPNSFS), quality of life (EQ5D5L)) and work ability (WAI). Measurement of these indicators took place at baseline, 1 week after the intervention and 3 months after the intervention.Patients in the MI group showed faster RTW and had a lower chance of relapse compared to those in the CAU condition. No significant differences were found between MI and CAU for the psychological outcomes.Based on our results, there is some evidence that counseling including MI helps work-disabled patients to RTW faster and experience less relapse. However, much remains unknown about the underlying psychological mechanisms explaining this effect. Suggestions are made for the full RCT.

Background: Close relatives provide much of the care to people with cancer. As resilience can shield family caregivers from mental health problems, there has been a burgeoning interest in resilience-promoting interventions. However, the evidence necessary for the development of these interventions is scant and unsynthesized. Aim: To create an overall picture of evidence on resilience in cancer caregiving by a theory-driven meta-synthesis. Design: In this systematically constructed review a thematic synthesis approach has been applied. The original findings were coded and structured deductively according to the theoretical framework. Consequently, the codes were organized inductively into themes and subthemes. Data sources: Through September 2019, five electronic databases were searched for qualitative studies on resilience in cancer caregiving. The search was extended by a supplementary hand search. Seventeen studies met the eligibility criteria. Results: The elements of resilience, as described in the pre-defined theoretical framework of Bonanno, are reflected in the lived experiences of family caregivers. The resilience process starts with the diagnosis of advanced cancer and may result in mental wellbeing, benefit finding, and personal growth. The process is influenced by context elements such as individual history, sociocultural background, caregiver characteristics, and the behavior of the supportive network. A repertoire of coping strategies that caregivers use throughout the caregiving process moderates the resilience process. Conclusion: This review and theoretical synthesis reveal key elements of resilience in the process of cancer caregiving, including influencing factors and outcomes. Implications and avenues for further research are discussed.

Background: When confronting a partner’s diagnosis of advanced cancer, family caregivers are often protected against severe psychological illness by their mental resilience. However, the current COVID-19 pandemic endangers this resilience through the daily threat of contagion exposure, viral transmission, isolation, and fear of death. Aim: To examine the experiences of partners caring for a person with advanced cancer during the COVID-19 pandemic. Setting: Twelve partners (all under the age of 65) of persons newly diagnosed with advanced cancer immediately before or during the pandemic were interviewed. An interpretative phenomenological approach was used in analyzing the data. Findings: Partners experience the COVID-19 pandemic as “living in a double cage.” Due to pandemic mandates and restrictions, the pace of their lives slows. However, COVID-19 does not slow the progression of the cancer, nor does it allow for an escape from the cancer. The pandemic has a significant impact on several elements of resilience. Nevertheless, the participants succeed in adapting and coping in a balanced and creative way despite the new challenges imposed by the pandemic. Conclusion: The COVID-19 pandemic challenges one’s resilience, a process that, under normal circumstances, may evolve while caring for a partner diagnosed with advanced cancer. Although most partners seem to cope adaptively with both advanced cancer and COVID-19, healthcare professionals should be aware of the risk of exhaustion. Furthermore, it can be presupposed that threatened, contextual factors that may support resilience should be preserved to increase the chances for a resilient outcome.

Interprofessional identity (IPI) development is considered essential in reducing incongruency and improving interprofessional collaboration. However, noticeable differences in conceptualizations are being put forward in the literature, hindering interpretation of research findings and translation into practice. Therefore, a Concept Analysis and Critical Interpretative Synthesis of empirical research articles were conducted to explore the assumptions and conceptions of IPI. Independent literature screening by two researchers led to the inclusion and extraction of 39 out of 1334 articles. Through critical analysis, higher order themes were constructed and translated to a synthesizing argument and a conceptual framework depicting what constitutes IPI (attributes), the boundary conditions (antecedents) and the outcomes (consequences) of its development. The attributes refer to both IPI’s structural properties and the core beliefs indicative of an interprofessional orientation. The antecedents inform us on the importance of IPI-fitting constructivist learning environments and intergroup leadership in enabling its development. This development may lead to several consequences with regard to professional wellbeing, team effectiveness and the quintuple aim. Given the educational orientation of this study, ways for facilitating and assessing the development of IPI among learners across the professional continuum have been proposed, although empirical research is needed to further validate links and mediating and moderating variables.

Given that sport-for-development (SfD) requires the intentional use of sport as a tool to realize developmental goals in complex contexts, there is a need for reflexive SfD coaches who can successfully contribute to the delivery of programmes. In this study, we explore the lived experiences of SfD coaches in a selection of programmes in Flanders, Belgium. We look at their responsibilities, perceived competencies and the conditions that need to be in place in order to realize SfD goals. Qualitative data spanning a four-year research project were analysed in order to understand how, why and in what contexts coaches contribute to SfD programmes. The analysis unearthed a boundary-spanning coach profile, establishing emotional connectivity, working in a transprofessional manner, and occupying professional hybridity that adapts to context continuously. These results provide an important contribution for SfD practice and policy, nourishing reflection on the ‘ideal’ SfD coach profile, and how it could be generated within the most complex times.

IntroductionLifestyle behaviours, including sedentary behaviour, have been listed as key modifiable factors to promote healthy ageing. Sedentary behaviour is ubiquitous in older adults and has a strong link with age-related functional declines and chronic health conditions. Although several interventions have been developed aimed at the reduction of sedentary behaviour in older adults, little in-depth information is available on how these complex interventions work in different contexts. Therefore, the aim of our study was to unpack the mechanisms of how existing interventions aimed at the reduction of older adults’ sedentary behaviour work or fail to work in particular contexts in order to optimise the development and implementation of future sedentary behaviour interventions.Methods and analysisA realist review will be conducted as a first part of the Stand UP Seniors (SUPS) project and will be structured as follows: (1) defining the scope of the review, (2) searching and appraising the evidence, (3) extracting data and synthesising the results, and (4) drawing conclusions and formulating recommendations. The result of this iterative process will be a final programme theory that can be used to identify which context triggers which mechanism, and in turn might elicit which outcome. The final programme theory will be used to inform the second and the third parts of the SUPS project, which are, respectively, the development and evaluation of a sedentary behaviour intervention in older adults.Ethics and disseminationEthical approval is not required for the review. Dissemination of the realist review results, including the final programme theory, will occur through peer-reviewed publications and presentations at relevant conferences. The peer-reviewed realist review will be prepared according to the Realist and Meta-narrative Evidence Synthesis: Evolving Standards publication standards for realist syntheses.PROSPERO registration numberCRD42021248795.

Objectives Motivation for return to work (RTW) reflects the degree of willingness to resume work activities and has been shown to be a crucial factor in long-term work disability. The satisfaction of basic psychological needs and motivation as described by the Self-Determination Theory (SDT) yield associations with outcomes such as quality of life and job satisfaction. The current study is the first study to examine whether motivation and basic psychological needs are predictive for RTW outcomes at 1-year follow-up. Methods About 349 people with a work disability (mean = 131.32 days off work) participated in this observational longitudinal research. Quality of motivation (MAWS) and basic psychological need satisfaction and frustration (BPNSFS) were measured at baseline. At 12-month follow-up, differences in RTW were assessed in terms of (1) time until RTW, (2) partial RTW, (3) relapse within 12 months, (4) work disability longer than 12 months. Binary logistic and cox regression analyses were used. Results Controlled motivation regarding the former job was related to shorter time until RTW. Autonomous motivation and amotivation did not seem predictive for RTW variables. The frustration of the basic needs was related to a longer work disability, need satisfaction was not related to the RTW variables. No significant predictors for relapse and partial RTW were found. Conclusions The frustration of basic psychological needs was predictive for a longer work disability. Controlled motivation on the other hand predicted faster RTW, which was an unexpected direction. SDT seems to have predictive value, yet underlying mechanisms remain unclear. ispartof: Journal Of Occupational Health vol:63 issue:1 ispartof: location:Australia status: Published online

In March 2020, the Your COVID-19 Risk tool was developed in response to the global spread of SARS-CoV-2. The tool is an online resource based on key behavioural evidence-based risk factors related to contracting and spreading SARS-CoV-2. This article describes the development of the tool, the produced resources, the associated open repository, and initial results. This tool was developed by a multidisciplinary research team consisting of more than 150 international experts. This project leverages knowledge obtained in behavioural science, aiming to promote behaviour change by assessing risk and supporting individuals completing the assessment tool to protect themselves and others from infection. To enable iterative improvements of the tool, tool users can optionally answer questions about behavioural determinants. The data and results are openly shared to support governments and health agencies developing behaviour change interventions. Over 60 000 users in more than 150 countries have assessed their risk and provided data.

Motivation may predict return to work (RTW), yet the measurement of motivation needs more scientific evidence. We adopt a dimensional approach, based on the self-determination theory (SDT), distinguishing between amotivation, controlled and autonomous motivation. We seek to explore the presence of these dimensions in sick-disabled patients, and are interested in associations with quality of life, depression, patient's predictions of RTW, and health care provider estimations of patient's motivation.A cross-sectional study in 336 patients was conducted. Motivation was assessed using the Motivation at Work Scale (MAWS) and examined in relation to patient outcomes, patient's prediction of RTW, and health care provider estimations of patients' motivation. A cluster analysis was performed, and differential associations between motivational profiles were explored.Cluster analysis revealed four profiles. Highly controlled profiles were most prevalent, reported poorer mental quality of life, and expected a longer time before RTW, regardless of the level of autonomous motivation. Interestingly, the health care provider's estimation was not related to controlled motivation.Our results show that SDT may help to differentiate people with a work disability regarding their motivation to RTW. Most notably, the devastating consequences of controlled motivation are discussed, and clinical implications are provided.Implications for RehabilitationAssessing the different dimensions of motivation in the context of RTW will be a significant advance as the self-report measures appear to be viable tools.Controlled motivation, which indicates that people are motivated to RTW but only because they "have to", has negative consequences yet a high prevalence and should therefore be addressed by the practitioner.Practitioners should keep in mind that employees are motivated by several motives at the same time, with some being more beneficial than others.Controlled motivation can be converted into autonomous (i.e., good quality) motivation by supporting autonomy of the patient, by supporting their relationships with colleagues, managers, and health care providers and by supporting their feeling of competence in the RTW process.

BackgroundGroups at risk of exclusion from society appear to have a lower health status and more health-related problems. Prevention efforts in these groups are not always successful, and new ways have to be sought by which health messages can be delivered. Many agree on low-threshold sport activities, also called ‘community sports’, to be a powerful tool to target socially vulnerable groups. Until now, it has not been investigated how and when such sport initiatives may be able to impact health outcomes in socially vulnerable populations. This study aims at developing a program theory that clarifies the mechanisms and necessary conditions for sport programs to be effective in health promotion. Such a program theory may constitute a backbone for developing health promotion initiatives within a sport for development setting.MethodsWe developed a program theory using a realist research design. We build on an extensive data set consisting of the insights of key stakeholders and participants of various community sport organizations at the one hand, and on relevant theoretical frameworks at the other hand. Data were collected through participatory observations of soccer trainings and related group activities, interviews with key stakeholders and participants, document analysis and two focus groups with stakeholders from associated social partnership organizations.ResultsThe health promoting effect of community sport on socially vulnerable groups seems not to result from an improved physical condition or sport-technical skills as such, but from processes of experiential learning among peers, incremental responsibility-taking and reflexivity. On the condition that participants feel safe, are stimulated to reflect and enabled to become actor of themselves and their situation, these processes are likely to lead to increased self-esteem, self-efficacy and motivation to set and pursue personal (health) goals. The key-influencing factor in these processes is the coach, who therefore needs to be adequately skilled in, for example, social vulnerability, motivational coaching and group dynamics.ConclusionsThe program theory developed in this study offers insights in the mechanisms proper to, and necessary conditions for community sport to be a lever for health promotion in socially vulnerable groups. Motivational processes at individual level and group connectivity are at the basis of personal health goal-setting. One of the necessary conditions is that these processes are guided by community sport coaches skilled in the meaning and impact of social exclusion, and capable of connecting with the target group.

BackgroundSocially excluded groups are at higher risk of low well-being and poor health. The link between social exclusion and health inequities is complex, and not being involved in society makes it difficult to be reached by standard prevention programs. Sport-for-development (SFD) programs are low-threshold and may be promising settings for inclusive actions. We explore the underlying mechanisms through which SFD might have an impact on social inclusion and examine the necessary conditions that work as a catalyst for these underlying mechanisms.MethodsA realist evaluation approach was adopted. A non-profit SFD organization in a middle-large city in Flanders, Belgium, formed the setting for a single case study. Document analysis, participatory observations, interviews, and a focus group, were sources for identifying necessary context elements and essential mechanisms through which SFD could promote its participants’ health and wellbeing.ResultsAmong the most efficient mechanisms triggered by the Foundation’s activities are learning by fun, connecting with peers (of whom some serve as role model) and engaging as a volunteer with some responsibilities. Building trust in oneself and in others is a necessary process throughout all these mechanisms. Facilitating context factors include the activities’ accessibility and unconditional approach (creating a sense of safety), the popularity of the first division football team the Foundation is associated with (leading to a sense of belonging), a steady network of social partners and a strongly positive relationship with the SFD coach(es).ConclusionsOur findings demonstrate that a SFD setting may be a vehicle for engaging hard-to-reach population groups. It enhances socially vulnerable persons’ sense of competence and connectedness, leading to opportunities to improve life and work skills transferrable outside SFD settings. Based on these findings, suggestions are provided that may enhance the field and help to develop feasible (policy-led) interventions designed to promote social inclusion.

Additional file 1. Overview of data collections.

Background: Despite the risk for developing mental disorders, the majority of advanced cancer patients’ family caregivers undergo a resilient process throughout the caregiving period. Research on resilience in caregivers of advanced cancer patients is scarce and further hindered by the lack of a univocal definition and a theoretical framework. Objectives: To provide clarity on the concept of resilience by proposing an integrative view that can support health care professionals and researchers in conducting and interpreting research on resilience. Methods: The review process was inspired by the hermeneutic methodology: a cyclic review process, consisting of repeated searching and analysing until data saturation is reached and focused on achieving a deeper understanding of ill-defined concepts. The definitions from eighteen reviews on resilience and the theoretical frameworks from eight concept analyses were analysed. The composing elements of resilience were listed and compared. Results: The American Psychological Association’s definition of resilience and Bonanno’s theoretical framework are suggested to guide further research on resilience. Moreover, four knowledge gaps were uncovered: (1) How do resilience resources interact? (2) What are the key predictors for a resilient trajectory? (3) How do the resilient trajectories evolve across the caregiving period? And (4) how does the patient’s nearing death influence the caregiver’s resilience? Conclusion: To address flaws in conceptualization and the resulting gaps in knowledge, we suggest a definition and a theoretical framework that are suited to allow heterogeneity in the field, but enables the development of sound interventions, as well as facilitate the interpretation of intervention effectiveness. ispartof: European Journal Of General Practice vol:26 issue:1 pages:79-85 ispartof: location:England status: published

Additional file 2. Initial Program Theory - CATCH Health promotion.

Cancer and nutrition-related problems are extremely distressing events and disturb functioning and daily life. It is recognized that the effects of stressors challenging well-being are mediated by the meaning attached to these stressors. As nutrition-related problems are often being experienced within couples, it is also important to gain understanding of a partner's interpretation of complaints and whether it coincides with that of the patient.To explore the meaning attached to nutrition-related problems, a qualitative approach was followed. Seven couples, each composed of a patient with cancer and his/her cohabiting life partner, participated. Data were collected through in-depth interviews and analyzed by an interpretative phenomenological approach.Nutrition-related problems among patients with advanced cancer are mostly perceived as destroying health and leading to loss of physical, psychological, and social health symbols. Because the meaning patients and their partners attach to nutrition-related problems is individual and dynamic, it is necessary to devote special attention to the issues on different occasions.The study findings can assist nurses and other professional caregivers in providing psychological support for couples confronted with nutrition-related problems in advanced cancer. It is important to take into account the meaning patients and partners attach to these nutrition-related problems.

Background: Communication is present in all encounters in care and of importance to create a caring relation. A good relation between patients, next of kin and health care staff is crucial, not lea ...

Een grijze epidemie dreigt voor Belgie en de meeste andere westerse landen. In 2012 stond de teller op 1,92 miljoen personen die 65 jaar of ouder waren, waarbij 0,57 miljoen personen 80 jaar of ouder waren.

OBJECTIVE: Self-management is a core theme within chronic care and several evidence-based interventions (EBIs) exist to promote self-management ability. However, these interventions cannot be adapted in a mere copy-paste manner. The current study describes and demonstrates a planned approach in adapting EBI's in order to promote self-management in community-dwelling people with chronic conditions. METHODS: We used Intervention Mapping (IM) to increase the intervention's fit with a new context. IM helps researchers to take decisions about whether and what to adapt, while maintaining the working ingredients of existing EBI's. RESULTS: We present a case study in which we used IM to adapt EBI's to the Flemish primary care context to promote self-management in people with one or more chronic disease. We present the reader with a contextual analysis, intervention aims, and content, sequence and scope of the resulting intervention. CONCLUSION: IM provides an excellent framework in providing detailed guidance on intervention adaption to a new context, while preserving the essential working ingredients of EBI's. PRACTICE IMPLICATIONS: The case study is exemplary for public health researchers and practitioners as a planned approach to seek and find EBI's, and to make adaptations. Query date: 2019-12-23 16:38:43 https://www.sciencedirect.com/science/article/pii/S0738399119304379?via%3Dihub ispartof: Patient Education And Counseling vol:103 issue:3 pages:589-596 ispartof: location:Ireland status: published

BackgroundFamily caregivers of advanced cancer patients are at risk for developing mental disorders. Despite this risk, the majority seem to adapt well, and throughout the caregiving period, their trajectory is characterised by healthy functioning. However, GPs struggle with making timely assessments of caregivers at risk for mental dysfunction, since they often fail to seek medical help for themselves and the appropriate research about resilience in cancer caregivers is scarce. Moreover, research is hampered by the lack of a universal definition or theoretical framework.AimTo propose a comprehensive definition and framework for further research in family caregiving for advanced cancer patients.MethodInspired by the hermeneutic methodology, reviews and concept analyses on resilience following a potentially traumatic event were searched and analysed. Conforming to the hermeneutic methodology, article collection from PubMed, EMBASE, CINAHL, and PsycInfo was followed by analysis and was stopped when saturation was reached. Elements consistently arising from the definitions of resilience were listed and the theoretical frameworks were compared.ResultsThe APA definition: ‘resilience is the process of adapting well in the face of adversity, trauma or threats’ and Bonanno’s framework ‘temporal elements of resilience’ are proposed.ConclusionThere is a need for studies on resilience in caregivers of advanced cancer patients. Resilience is context-dependent, hence, study results cannot be transferred as such from one clinical situation to another. Furthermore, conceptual ambiguities hinder the interpretation and comparison of study results. For further research on resilience in caregivers of advanced cancer patients, we suggest the APA definition of resilience and Bonanno’s framework.

Purpose: Nutrition-related problems are common in patients with advanced cancer. They can disrupt daily life and routines. This study aimed to explore how couples cope with this source of distress. Methods: A qualitative descriptive study design was adopted using semi-structured interviews. Seven couples, each consisting of an advanced cancer patient and his or her co-habiting life partner, participated. The Qualitative Analysis Guide of Leuven (QUAGOL) was used as a guide to facilitate the analysis process. Results: When a patient communicates nutrition-related problems to the partner, individual coping is often complemented by interactive couple-coping pathways, serving two resilient coping strategies: maintaining normality and creating a new normality. These pathways can have either a practical, an emotional or a distant orientation. Different couple-coping pathways can be observed in the same couple when they are dealing with either one or multiple nutrition-related problems. Some couples, however, seem to cope more rigidly, often those with less observed ‘we-ness’. Conclusions: Nutrition-related problems are inherent to advanced cancer and are perceived as health-threatening. Couple-coping with nutrition-related problems is a dynamic and interactive process leaning on different coping pathways. There is no evidence that one pathway is superior to another, as they all serve a resilient coping strategy. Our findings can assist homecare nurses and other professional caregivers in providing psychological support and advice to couples confronted with nutrition-related problems in advanced cancer. Future research should shed light on whether an unsuitable match in coping styles within a couple is one of the precursors of non-resilient outcomes. ispartof: European Journal of Oncology Nursing vol:38 pages:76-84 ispartof: location:Scotland status: Published online

BackgroundWhen suffering from chronic pain, attempts to control or avoid pain often compete with other daily activities. Engaging in one activity excludes engaging in another, equally valued activity, which is referred to as “goal conflict.” As yet, the presence and effects of goal conflicts in patients with chronic pain remain poorly understood.MethodsThis study systematically mapped the presence and experience of goal conflicts in patients with fibromyalgia compared to healthy controls. A total of 40 patients and 37 controls completed a semi-structured interview in which they first reconstructed the previous day, identified conflicts experienced during that day, and classified each of the conflicting goals in one of nine goal categories. Additionally, they assessed how they experienced the previous day and the reported conflicts.ResultsResults showed that patients did not experience more goal conflicts than healthy controls, but that they did differ in the type of conflicts experienced. Compared to controls, patients reported more conflicts related to pain, and fewer conflicts involving work-related, social or pleasure-related goals. Moreover, patients experienced conflicts as more aversive and more difficult to resolve than control participants.DiscussionThis study provides more insight in the dynamics of goal conflict in daily life, and indicates that patients experience conflict as more aversive than controls, and that conflict between pain control (and avoidance) and other valued activities is part of the life of patients.

Objective Self-determination theory (SDT) may be a useful framework to understand why chronic pain affects partners. SDT postulates that individuals can engage in helping behaviors for different motives varying from more autonomous or volitional motives to more controlled or pressured motives. This article examines the relationship between partners' type of motivation to help (i.e., autonomous vs controlled) and their personal and relational functioning. Furthermore, mechanisms underlying this relationship (i.e., helping exhaustion and relationship-based need satisfaction) were examined. Methods In a sample of 48 couples, of which one partner had chronic pain (36 female patients), questionnaires measuring life satisfaction, positive and negative affect, anxiety and depressive feelings, relationship quality and relationship-based need satisfaction were filled out. Individuals with chronic pain (ICPs) also reported on pain intensity and disability whereas partners were requested to report on motives for helping and helping exhaustion. Results Data analysis with Structural Equation Modeling revealed that autonomous, relative to controlled, motives for helping among partners related positively to partners' well-being and relationship quality, and negatively to distress. The experience of helping exhaustion and relationship-based need satisfaction mediated these associations. Moreover, partners' autonomous helping motivation related positively to patient-reported relationship quality among ICPs high in pain intensity. Conclusions Applying SDT in a context of pain provides new insights into why chronic pain affects partners and how partners impact patient outcome. Directions for future research are outlined.

Objectives: In individuals with chronic pain (ICPs), controlling pain often is a salient goal, despite the difficulty to achieve it. This situation may bring along frustration and distress. Yet much remains unknown about the content, appraisal, and structure of goals that ICPs pursue. Here, we explore these goals, and specifically focus upon possible differences and interrelations between pain control goals (e.g., "to control my pain") and non-pain goals (e.g., "to go to work"). Design and Methods: "Personal Project Analysis" was used in 73 ICPs (48 females; 25 males; M-age = 49.85 years; SD = 9.72) to elicit goals and goal appraisals. Interrelations between pain and non-pain goals, namely interference (i.e., negative influence), facilitation (i.e., positive influence), and necessary condition (i.e., conditional relation between pain control goal and non-pain goals) were measured with three items. Self-report measures of pain intensity, pain catastrophizing, problem solving and acceptance were completed. Results: Participants reported a variety of goals. Appraisals of pain control goals were less favorable than appraisals of non-pain goals. ICPs with higher acceptance and meaningfulness of life reported more control over pain goals, and more progress in reaching pain control goals. These individuals also reported an overall much more positive appraisal of non-pain goals (i.e., less stress, difficulty, more progress, control). In contrast, high catastrophizing and the need to solve pain were negatively related to goal appraisals. Importantly. ICP's with high perceived meaningfulness of life despite pain experienced less necessity to achieve pain control goals in order to achieve non-pain goals. This was opposite for individuals with high levels of catastrophizing. Discussion: An understanding of why ICPs may become stuck in attempts to control their pain does not only require an understanding of how individuals appraise their pain, but also requires an understanding of how pain and non-pain goals interrelate. In particular, the view that controlling pain is necessary in order to be able to achieve other goals seems detrimental.

Instruments to assess chronic pain acceptance have been developed and used. However, whether and to what extent the content of the items reflects acceptance remain uninvestigated. A content analysis of 13 instruments that aim to measure acceptance of chronic pain was performed. A coding scheme was used that consisted of 3 categories representing the key components of acceptance, that is, disengagement from pain control, pain willingness, and engagement in activities other than pain control. The coding scheme consisted of 5 additional categories in order to code items that do not represent acceptance, that is, controlling pain, pain costs, pain benefits, unclear, and no fit. Two coders rated to what extent the items of acceptance instruments belonged to one or more of these categories. Results indicated that acceptance categories were not equally represented in the acceptance instruments. Of note, some instruments had many items in the category controlling pain. Further analyses revealed that the meaning of acceptance differs among different instruments and among different versions of the same instrument. This study illustrates the importance of content validity when developing and evaluating self-report instruments. Perspective This article investigated the content validity of questionnaires designed to measure acceptance in individuals with chronic pain. Knowledge about the content of the instruments will provide further insight into the features of acceptance and how to measure them.&nbsp

Hartfalen is een progressieve chronische aandoening die wereldwijd en in Belgie een belangrijk en toenemend gezondheidsprobleem vormt. Volgens de meest recente cijfers van het Agentschap Zorg en Gezondheid bedraagt de prevalentie in onze populatie ongeveer 1%.

Pain relief is often the primordial treatment objective in pain patients. However, an exclusive focus upon pain relief may have costs. Evidence is accumulating that persistent attempts to gain control over pain may, paradoxically, hinder successful adaptation to pain and increase frustration and limitations due to pain. To better understand these apparently paradoxical findings, we propose to adopt a motivational perspective on coping with pain. Within this perspective, pain control is recast as an attempt to protect and restore valued life goals threatened by pain. This framework explains why some patients engage excessively in pain control strategies despite the costs associated with this, such as overuse of medication. A clinical implication is that cautiousness is warranted in promoting strategies exclusively aimed at pain relief. Beyond standard medical care, interventions should also be aimed at the improvement of functioning despite pain. Certainly those patients for whom there is no definite or sound cure to pain and who increasingly experience emotional and physical problems due to pain might benefit from paramedical help by psychologists and/or physiotherapists.

Contains fulltext : 88965.pdf (Publisher’s version ) (Closed access) BACKGROUND: The Illness Cognition Questionnaire (ICQ; Evers et al., J Consult Clin Psychol, 69:1026-1036, 2001) assesses three ways of cognitively evaluating the stressful and aversive character of a chronic illness: helplessness, acceptance, and perceived benefits. PURPOSE: The purpose of this study was to evaluate the construct validity of the ICQ in individuals with chronic pain and patients with chronic fatigue. METHOD: The ICQ was administered to 821 individuals with chronic pain and 295 patients with chronic fatigue. Confirmatory factor analyses were performed to assess the hypothesized three-factor structure, containing the factors "helplessness," "acceptance," and "perceived benefits." A multigroup analysis was performed to investigate the stability of the factor structure in both groups. RESULTS: Results confirmed the three-factor structure in the two samples. The factor structure was invariant across individuals with chronic pain and chronic fatigue. CONCLUSION: As the three-factor structure provided a good fit in both groups, we confirm the usefulness of the subscale scores in research and clinical practice. 01 juni 2010