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Purpose This study aims to reflect on ways that the experiences of vulnerable users of drug and alcohol services can inform social work practice and policy to improve treatment engagement and mitigate negative responses to interventions. Design/methodology/approach The research used semi-structured interviews and photovoice in an interpretative phenomenological analysis of the experiences of people in treatment for drug or alcohol problems whose child was the subject of a Child Protection or Child in Need order. Findings The research gave insights into participants’ experiences of loss of control, unfairness and stigma. Participants described how they felt powerless in the social services system and were afraid to be open and honest with practitioners for fear of having their children removed. Practical implications The research highlighted the need for more training and professional development for social work practitioners to address power imbalance issues, and the need to promote non-threatening professional practice that removes penalties for disclosure of substance use, enabling substance users who are parents to be more honest about their drug use. Social implications The research showed the value of phenomenological methods for investigating sensitive issues with vulnerable users of treatment services in a way that can inform policy and practice. Originality/value This paper explores ways that phenomenological research with vulnerable, hard-to-reach participants can produce insights about the potential benefits of social work practice that is non-threatening and encourages greater openness and honesty among substance users who are parents.

This article explores the emotional experiences of drug- and/or alcohol-using parents who have child protective Social Services involvement. Research suggests that protective processes can reduce children’s experience of poor outcomes whilst parents undergo treatment for substance misuse. Semi-structured interviews combined with photovoice and journal writing were used to generate data. Eight UK-based parents participated. Each was accessing drug or alcohol treatment and had a child who was the subject of a child protection intervention. The resulting data from the seventeen interviews were analysed using Interpretative Phenomenological Analysis (IPA). Key findings are presented within four themes. The first two outline parents’ perceptions of themselves and how they felt they were viewed by others. Themes 3 and 4 focus on specific emotions: anger and frustration; fear and guilt. The research identifies the complex nature of parental emotions surrounding drug/alcohol misuse when social care services are involved. Parents conceptualised their experience as psychological trauma. They discussed the emotional roller-coaster of the effects of having combined interventions. The research provides insights into how drug/alcohol use can influence parenting. It also highlights issues for professional practice, including developing successful treatment models for substance-using parents.

Background/Aims: People receiving in-centre haemodialysis (ICHD) during the COVID-19 pandemic had to adjust to more challenging treatment conditions. This article aims to explore people's experiences of adjustment to ICHD during the pandemic. Methods: Thematic analysis of in-depth, semi-structured interviews with 14 adult UK ICHD patients. Findings: A total of four themes were identified: perceptions of the threat, impacts on treatment, impaired communication and coping and positive adjustment. These themes described participants' experiences of vulnerability to COVID-19; the ways the pandemic affected dialysis and clinical care; the impact that measures to reduce viral transmission had on communication and interaction within dialysis units; and ways that participants coped and made positive adjustments to the adversities imposed by the pandemic. Conclusions: The findings give insights into adjustment during extreme adversity. They also help to identify how support for ICHD patients could be improved as pandemic conditions recede and ways that dialysis units could prepare for future outbreaks of infectious illness.

Background: Many people with end-stage chronic kidney disease continued attending clinical centres for dialysis despite the risk of contracting COVID-19 and developing severe disease. Aims: To assess the impact of COVID-19 on patients' adjustment and wellbeing. Methods: Some 40 people (18 female, 22 male) receiving in-centre haemodialysis reported COVID-19-related adverse impacts on treatment and rated their COVID-19-related concerns, then completed the Depression, Anxiety and Stress Scale-21 and four scales of the Kidney Disease Quality of Life Short Form. Findings: The most common adverse impacts were staff shortages/changes and impaired interaction with staff/patients. Of the sample, 32.4% were severely depressed, 14.7% severely anxious and 18.9% severely stressed. Participants who had tested positive for COVID-19 were more depressed and reported more adverse impacts. Older and married/cohabiting participants had better adjustment and wellbeing. Conclusions: The results help to identify patients with the greatest needs and suggest ways to maintain patient wellbeing during outbreaks of infectious disease.

PurposeThe prevalence and multi-system nature of post-COVID-19 symptoms warrants clearer understanding of their work ability implications within the working age population. An exploratory survey was undertaken to provide empirical evidence of the work-relevant experiences of workers recovering from COVID-19.Design/methodology/approachA bespoke online survey based on a biopsychosocial framework ran between December 2020 and February 2021. It collected quantitative ratings of work ability and return-to-work status, qualitative responses about return-to-work experiences, obstacles and recommendations, along with views on employer benefits for making accommodations. A sample of 145 UK workers recovering from COVID-19 was recruited via social media, professional networks and industry contacts. Qualitative data was subject to thematic analysis. Participants were mainly from health/social care (50%) and educational settings (14%).FindingsJust over 90% indicated that they had experienced at least some post-COVID-19 symptoms, notably fatigue and cognitive effects. For 55%, symptoms lasted longer than six months. Only 15% had managed a full return-to-work. Of the 88 who provided workability ratings, just 13 and 18% respectively rated their physical and mental workability as good or very good. Difficulties in resuming work were attributed to symptom unpredictability, their interaction with job demands, managing symptoms and demands in parallel, unhelpful attitudes and expectations. Manager and peer support was reported as variable.Originality/valueWorkplace health management characterised by flexible long-term collaborative return-to-work planning, supported by more COVID-centric absence policies and organisational cultures, appear pivotal for sustaining the return-to-work of the large segments of the global workforce affected by post-COVID-19 symptoms.

Helping women to stop smoking during pregnancy is a major priority for health professionals and evidence suggests that financial incentives can be effective. With the aim of maximising the benefits and minimising unintended negative consequences, this paper gives a brief review of evidence about using financial incentives for smoking cessation during pregnancy, with a special emphasis on how financial incentives work. The review showed that financial incentives can increase pregnant women’s capability, opportunity and motivation to stop smoking. The evidence supports five specific recommendations about how financial incentives should be used in future to reduce smoking during pregnancy, including measures to increase public acceptability. These recommendations can contribute to updating published UK policy for smoking cessation during pregnancy, including the National Institute for Health and Care Excellence (NICE) guideline on stopping smoking in pregnancy and after childbirth (PH26).

Individuals with alexithymia struggle to make sense of their emotions. Alexithymia has been associated with a range of physical illnesses, but may influence different illnesses differently, so to understand the role of alexithymia in illness it is important to focus on specific conditions. This article reviews evidence from ten reports published between 2000 and 2018 of studies with samples of adults with chronic back pain that used the Toronto Alexithymia Scale (TAS). The studies were conducted in Germany, Israel, Italy, Russia, Turkey and the US. Eight studies involved clinical samples and two involved public transit workers. Studies that compared participants with high and low alexithymia consistently found associations with measures of pain. The findings show that more severe alexithymia plays a role in the experience of chronic back pain, and support the incorporation of alexithymia-related elements in interventions to help people with chronic back pain improve their emotional regulation and reduce their pain-related distress.

Initial management of the acute pain crisis (APC) of sickle cell disease (SCD) is often unsatisfactory, and might be improved by developing a standardised analgesia protocol. Here, we report the first stages in developing a standard oral protocol for adolescents and adults. Initially, we performed a dose finding study to determine the maximal tolerated dose of sublingual fentanyl (MTD SLF) given on arrival in the acute care facility, when combined with repeated doses of oral oxycodone. We used a dose escalation algorithm with two dosing ranges based on patient’s weight (50 kg). We also made a preliminary evaluation of the safety and efficacy of the protocol. The study took place in a large tertiary centre in London, UK. Ninety patients in the age range 14–60 years were pre-consented and 31 treatment episodes were evaluated. The first 21 episodes constituted the dose escalation study, establishing the MTD SLF at 600 mcg (>50 kg) or 400 mcg (

Problematic use of prescribed and over-the-counter analgesics is widespread and increasing among people with chronic pain, but the availability of preventative and treatment services is limited. We evaluated a 21-day online intervention based on compassionate mind training in a prospective, randomized-controlled trial. The participants were 73 adults with concerns about their use of analgesics for chronic pain conditions. Participants completed measures of analgesic use, misuse and dependence, plus self-criticism and self-reassurance (self-inadequacy, self-reassurance, and self-hate), cognitive impulsivity (negative urgency, lack of perseverance, lack of premeditation, sensation-seeking, and positive urgency) and behavioral impulsivity (delay discounting) at baseline, postintervention, and 1-week postintervention follow-up. Following baseline assessment, participants were randomized to compassionate mind training (CMT; n = 38) or relaxation music (n = 35), both delivered online. No adverse events or safety issues were reported and high participant retention and exercise completion rates showed that the intervention was acceptable to participants. Repeated measures analysis of variance showed that by comparison with relaxation music, the CMT group had reduced prescription analgesic use, F = 6.123, p = .015, analgesic dependence, F = 14.322, p < .001, self-hate, F = 12.218, p < .001, negative urgency, F = 7.323, p = .006, and lack of perseverance, F = 7.453, p = .001, from baseline to postintervention, and those improvements were maintained at follow-up. The results show that exercises based on CMT principles and techniques and delivered online can reduce analgesic use, risk of analgesic dependence, and some aspects of self-criticism and impulsivity. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Healthcare providers' own death anxiety can influence end-of-life communication. We interviewed nine palliative care health providers about their experiences of providing end-of-life care. Participants also completed the Revised Death Anxiety Scale. A thematic analysis of the interview transcripts identified one theme labeled "avoidant coping" and another labeled "death anxiety awareness"; each is presented in the context of the participants' own Revised Death Anxiety Scale scores. The findings show that avoidant death anxiety coping can compromise end-of-life communication, but that greater awareness of death anxiety can help overcome avoidant coping. The findings can inform potential improvements in healthcare practice and training.

Objectives Primary dysmenorrhea causes menstrual pain that affects women’s quality of life (QoL) and analgesics are only moderately effective. Pain coping and pain acceptance influence QoL among people affected by other chronic pain conditions, so we examined pain coping, pain acceptance and analgesic use as predictors of QoL among women with primary dysmenorrhea. Study design 145 women with primary dysmenorrhea completed an online survey including the Menstrual Symptoms Questionnaire (MSQ), the Coping Strategies Questionnaire (CSQ), the Chronic Pain Acceptance Questionnaire (CPAQ-8), questions about analgesic use, and the Short Form-12 (SF-12), a measure of physical and mental health-related QoL. Results In multiple regression, pain acceptance predicted better physical and mental QoL, whereas pain coping did not predict mental or physical quality of life. Being married or cohabiting and menstrual pain that was less severe and shorter in duration predicted better physical QoL, and those effects were mediated by pain acceptance. Being older at the onset of painful periods predicted better mental QoL and that effect was also mediated by pain acceptance. More severe menstrual pain and congestive rather than spasmodic dysmenorrhea predicted worse mental QoL but those effects were not mediated by other factors. Analgesic use did not predict physical or mental QoL. Conclusions The results show the impact that menstrual pain has on women’s quality of life, and suggest that initiatives to increase pain acceptance among women with menstrual pain are worthwhile. More research is needed to understand more fully the factors that influence health-related quality of life among women with menstrual pain.

Aim: To identify risk factors for pain medication dependence. Materials & methods: Chronic spinal pain outpatients (n = 106) completed the Leeds Dependence Questionnaire (LDQ) and measures of potential risk factors. Participants with high (n = 3) and low (n = 3) dependence were interviewed. Results: Mean LDQ score was 11.52 (standard deviation 7.35) and 15/106 participants (14.2%) were severely dependent (LDQ ≥20). In linear regression, pain intensity (β = 0.313, p

Background Theory-based intervention materials must be carefully adapted to meet the needs of users with specific physical conditions. Acceptance and Commitment Therapy (ACT) has been adapted successfully for cancer, chronic pain, diabetes, irritable bowel syndrome, multiple sclerosis, and a range of other conditions, but not so far for people receiving renal haemodialysis. This paper presents findings from a study to adapt ACT-based intervention materials specifically for renal dialysis. Methods Draft written materials consisting of four stories depicting fictitious individuals who used ACT-related techniques to help overcome different challenges and difficulties related to dialysis were adapted using a systematic patient consultation process. The participants were 18 people aged 19–80 years, with chronic kidney disease and receiving renal dialysis. Individual, semi-structured interviews were conducted to elicit participants’ views about how the content of the draft materials should be adapted to make them more realistic and relevant for people receiving renal dialysis and about how the materials should be presented and delivered to people receiving renal dialysis. The interview transcripts were analysed using a qualitative adaptation of the Delphi method in which themes are used as a framework for translating feedback into proposals for modifications. Results The analysis of patient feedback supported the use of patient stories but suggested they should be presented by video and narrated by real dialysis patients. They also indicated specific adaptations to make the stories more credible and realistic. Participant feedback was translated into proposals for change that were considered along with clinical, ethical and theoretical factors. The outcome was a design for a video-based intervention that separated the stories about individuals from the explanations of the specific ACT techniques and provided greater structure, with material organised into smaller chunks. This intervention is adapted specifically for people receiving renal dialysis while retaining the distinctive theoretical principles of ACT. Conclusions The study shows the value of consulting patients in the development of intervention materials and illustrates a process for integrating patient feedback with theoretical, clinical and practical considerations in intervention design.

Methadone is a synthetic opiate that is used to treat dependence on heroin and related drugs. The most important and most studied adherence variable is treatment retention, because of the strong link between time spent in treatment and long-term treatment outcome. Detoxification is usually just one of several phases of treatment for opiate dependence, and is usually intended to be followed by interventions to reduce the risk of relapse to drug use. The aim is to eliminate the acute physical dependence on opiates while providing whatever supportive and therapeutic resources are available. Treatment retention and use of illicit drugs during treatment are the main aspects of adherence to have been examined in methadone maintenance. The conclusions that can be drawn from this summary of research findings would probably confirm the clinical impressions of those involved in providing methadone-based treatment services for opiate dependence.

This article provides a reflective account of our work on a project at the University of Derby and Bart’s Health NHS Trust, London, to evaluate a questionnaire measure of sickle cell disease (SCD) patients’ satisfaction with hospital care. Romaana Kapadi’s involvement was supported by a university internship and scholarship, and this article covers the skills she gained as an undergraduate student researcher, and how the opportunity helped with her plans to become a health psychologist. We hope this article will inspire other undergraduate students to grasp opportunities like this, and encourage lecturers to get students more involved with their research, as well as illustrating the role that health psychologists can play in improving healthcare for people with SCD.

Renal dialysis is a life-saving treatment for end-stage renal disease (ESRD) but is burdensome, invasive and expensive. Patients’ experiences of dialysis and the outcomes of their treatment could potentially be improved by focusing on ‘acceptance’. However, the concept of acceptance has been used in different ways. This article examines ways that acceptance has been conceptualised in research on chronic illness generally and ESRD specifically, and makes proposals for research to understand better what acceptance means for people with ESRD. The aim is to assist the development of acceptance-related measures and interventions to support people with ESRD.

Motivational and behavioural models of adjustment to chronic pain make different predictions about change processes, which can be tested in longitudinal analyses. We examined changes in motivation, coping and acceptance among 78 men with chronic haemophilia-related joint pain. Using cross-lagged regression analyses of changes from baseline to 6 months as predictors of changes from 6 to 12 months, with supplementary structural equation modelling, we tested two models in which motivational changes influence behavioural changes, and one in which behavioural changes influence motivational changes. Changes in motivation to self-manage pain influenced later changes in pain coping, consistent with the motivational model of pain self-management, and also influenced later changes in activity engagement, the behavioural component of pain acceptance. Changes in activity engagement influenced later changes in pain willingness, consistent with the behavioural model of pain acceptance. Based on the findings, a combined model of changes in pain self-management and acceptance is proposed, which could guide combined interventions based on theories of motivation, coping and acceptance in chronic pain. This study adds longitudinal evidence about sequential change processes; a test of the motivational model of pain self-management; and tests of behavioural versus motivational models of pain acceptance. [Abstract copyright: © 2017 European Pain Federation - EFIC®.]

Critical thinking is an important focus in higher education and is essential for good academic achievement. We report the development of a tool to measure critical thinking for three purposes: (i) to evaluate student perceptions and attitudes about critical thinking, (ii) to identify students in need of support to develop their critical thinking, and (iii) to predict academic performance. Seventy-seven items were generated from focus groups, interviews and the critical thinking literature. Data were collected from 133 psychology students. Factor Analysis revealed three latent factors based on a reduced set of 27 items. These factors were characterised as: Confidence in Critical Thinking; Valuing Critical Thinking; and Misconceptions. Reliability analysis demonstrated that the sub-scales were reliable. Convergent validity with measures of grade point average and argumentation skill was shown, with significant correlations between subscales and validation measures. Most notably, in multiple regression analysis, the three sub-scales from the new questionnaire substantially increased the variance in grade point average accounted for by measures of reflective thinking and argumentation. To sum, the resultant scale offers a measure that is simple to administer, can be used as a diagnostic tool to identify students who need support in developing their critical thinking skills, and can also predict academic performance.

A brief measure of patient satisfaction with treatment for pain is needed to help improve the treatment of painful episodes caused by sickle cell disease (SCD), especially during and after the transition from paediatric to adult care. Focus groups of 28 adolescent and adult patients were consulted about the content, clarity and relevance of 30 potential items, resulting in an 18-item version. This was validated by analysing questionnaire responses from 120 patients aged 12-53 years. Confirmatory factor analysis and item analysis indicated five subscales with high internal reliability: 'Communication and Involvement' (6 items, α = 0·87); 'Respect and Dignity' (3 items, α = 0·82); 'Pain Control' (3 items, α = 0·91); 'Staff Attitudes and Behaviour' (4 items, α = 0·88); and 'Overall Satisfaction' (2 items, α = 0·85) plus a Total Satisfaction score (18 items, α = 0·96). High negative correlations with the Picker Patient Experience Questionnaire, a measure of problem experiences, indicated good convergent validity. Lower satisfaction scores among patients aged over 18 years, those admitted via the emergency department, those treated by non-specialist hospital staff, and those reporting more breakthrough pain indicated good concurrent validity. The questionnaire provides a convenient brief measure that can be used to inform and evaluate improvements in healthcare for adolescent and adult patients with SCD, and could potentially be adapted for other painful conditions.

Objectives Transitioning from clinical care to community-based self-management represents a significant challenge, throughout which social support can facilitate health adjustment and quality of life. However, community-centred, peer-led support structures are often underused. This study aimed to investigate the decision-making processes involved in the choice to attend a chronic pain support group (CPSG) following discharge from a Pain Management Programme. Design An in-depth, qualitative analysis was undertaken using interpretative phenomenological analysis, exploring participants’ subjective experiences, decision-making, and rationale for initial CPSG attendance. Methods Twelve participants (four males, eight females) were recruited from a regional CPSG and completed semi-structured interviews lasting between 45 and 120 min. Interviews were transcribed verbatim and analysed idiographically before a cross-case analysis was completed. Results Analysis of transcripts resulted in three superordinate themes: (1) The thirst for comparative friendship; (2) conjecture and the imminent choice; (3) progressive pain management. These themes reflect a desire for empathic, socially comparative friendships and the search for a forum in which to enhance pain self-management strategies, yet also internal conflict over initial CPSG attendance. Conclusion Social support and associated friendships are attractive to prospective CPSG members and are conceptualized as opportunities to engage in social comparison and nurture self-care. The first visit to the support group presents a significant hurdle, but can be facilitated by managing the transition between therapeutic care and CPSG attendance. Clinicians can challenge preconceptions, foster positive viewpoints regarding the group and support collective decision-making to attend. Following initial attendance, psychosocial well-being was enhanced. Statement of contribution What is already known on this subject? Social support functions as a protective buffer against declining health. Joining a peer-led support group can be initially intimidating and the first visit presents a significant hurdle. What does this study add? Participants are predominantly attracted to support groups due to the opportunity to develop new friendships. Health-related peer groups function as fora for social comparison, enhancing self-esteem and self-efficacy. Experience of pain management programmes primes willingness to attend support groups. The initial decision to attend is difficult but facilitated by collective, group decision-making processes. Health care professionals dynamically prime the transition towards peer support structures.

INTRODUCTION Haemophilia is an inherited chronic condition that causes bleeding in the joints and soft tissue. Healthy siblings growing up in the family of a person with haemophilia can be affected socially and psychologically. AIM To explore qualitatively the experiences of healthy siblings who grew up with a brother with severe haemophilia. METHODS Eleven healthy siblings (10 female, one male) who grew up with a brother with severe haemophilia A were recruited via the Haemophilia Society UK. The verbatim transcripts of individual semi-structured interviews were analysed using interpretative phenomenological analysis (IPA). RESULTS Three themes were identified as follows: lack of parental attention, negative social emotions, and carrier status anxiety. Participants described having engaged in attention-seeking behaviours because they felt they lacked parental attention. They also described the resentment, anger and frustration they felt about the effect their brothers' haemophilia had on their lives. Female participants described the impact their carrier status or lack of it had on their lives. CONCLUSION These findings could be translated into better advocacy and support for siblings through haemophilia centres. More research is also needed on how healthy siblings are affected by haemophilia, including studies guided by family systems theory.

The experience of long-term membership of a successful chronic pain support group (CPSG) was explored to identify; (i) factors associated with social support, and; (ii) ways that health care professionals (HCPs) could help CPSGs become more effective and supportive.Interpretative Phenomenological Analysis enabled exploration of participants' experiences of membership and rationales for continued attendance.Twelve participants (four males, eight females), recruited from a regional CPSG, completed semi-structured interviews lasting from 45 to 120 minutes. Following verbatim transcription, idiographic then cross-case analyses were undertaken.Three superordinate themes emerged: (1) Investing in the new normal; (2) The nurturing environment; (3) Growth facilitation through social evolution. Increased investment and identification with membership, generated snowballing social engagement, enhancing pain management/well-being through collective humour and peer-to-peer support. Explicit guidance by HCPs in early stages of group formation/development, and subsequent implicit influences on group attitudes and actions, promoted the group's development into its current healthy, supportive state.Contrary to stereotypes, membership offered positive respite from chronic pain through collective coping. Successful CPSGs forge an independent identity, fostering strong group investment and an ability to live well with chronic pain. HCPs can provide a stabilising foundation for CPSGs to develop positively and supportively.

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One approach to plagiarism prevention focuses on improving students' authorial identity, but work in this area depends on robust measures. This paper presents the development of a psychometrically robust measure of authorial identity – the Student Attitudes and Beliefs about Authorship Scale. In the item generation phase, a pool of items was developed and assessed for content validity by subject matter experts. In the exploratory phase, data from 439 higher education students were used to identify a latent variable model with three factors: ‘authorial confidence’, ‘valuing writing’ and ‘identification with author’. In the confirmatory phase, data from 306 higher education students were used to test the three-factor model's reliability and validity. The three-factor structure was confirmed, and the results showed that the SABAS has a stronger psychometric basis than previously available measures. This measure of authorial identity can be used with confidence in research and pedagogy to help students improv...

Objectives: To describe the coping strategies that men and women adopted during the early stages of in vitro fertilisation treatment, and explore why and how they selected those strategies. Background: Previous research has identified coping strategies used during fertility treatment and the impact of those strategies on adjustment, but not how and why individuals choose the strategies they do, which is important for understanding coping strategy use as a self-regulatory process. Methods: Three heterosexual couples took part in 2 or 3 individual semi-structured interviews over 6 months, producing 14 accounts, which were analysed using interpretative phenomenological analysis. Results: The emergent themes were: not dwelling on emotional issues; getting on with treatment; and keeping busy with other things. Participants selected coping strategies in a conscious, deliberate way, by making comparisons with other patients and by drawing on their broader, customary ways of coping. The strategies participants ad...

Background Interventions based on coping and acceptance can be adapted for people with different painful conditions. Evidence about baseline characteristics that predict improved outcomes is informative for matching people to interventions, whereas evidence about changes that predict improved outcomes is informative about the processes that interventions should target. Methods Participants in a low-intensity programme to promote self-management of haemophilia-related chronic joint pain (n = 101) reported pain intensity, coping, acceptance and quality of life at baseline and 6-month follow-up. Baseline and change measures of pain intensity, coping and acceptance were used to predict follow-up quality of life, taking account of baseline quality of life. Results Changed (reduced) pain intensity predicted better physical quality of life, independently of age, haemophilia severity, baseline pain intensity and baseline physical quality of life. Lower baseline passive coping and changed (increased) pain acceptance predicted better mental quality of life, independently of age, severity and baseline mental quality of life. Increased activity engagement but not pain willingness predicted better mental quality of life when pain acceptance was decomposed. Changed (reduced) negative thoughts also predicted better mental quality of life when separate acceptance subscales were used. Active pain coping did not predict physical or mental quality of life. Conclusions Initially high levels of passive coping may be an obstacle to improving mental quality of life. Acceptance rather than coping may be a more useful behavioural change target, but more research is needed about the meanings and therapeutic implications of different elements of pain acceptance.

A DVD (digital video disk) intervention to increase readiness to self-manage joint pain secondary to hemophilia was informed by a 2-phase, motivational-volitional model of readiness to self-manage pain, and featured the personal experiences of individuals with hemophilia. The DVD was evaluated in a randomized controlled trial in which 108 men with hemophilia completed measures of readiness to self-manage pain (Pain Stages of Change Questionnaire) before and 6 months after receiving the DVD plus information booklet (n = 57) or just the booklet (n = 51). The effect of the DVD was assessed by comparing changes in Pain Stages of Change Questionnaire scores (precontemplation, contemplation, and action/maintenance) between groups. The impact on pain coping, pain acceptance, and health-related quality of life was tested in secondary analyses. Repeated-measures analysis of variance, including all those with complete baseline and follow-up data regardless of use of the intervention, showed a significant, medium-sized, group × time effect on precontemplation, with reductions among the DVD group but not the booklet group. Significant use × time effects showed that benefits in terms of contemplation and action/maintenance were restricted to those who used the interventions at least once. The results show that low-intensity interventions in DVD format can improve the motivational impact of written information, and could be used to help prepare people with chronic pain for more intensive self-management interventions. The findings are consistent with a 2-phase, motivational-volitional model of pain self-management, and provide the first insights to our knowledge of readiness to self-manage pain in hemophilia.

A mixed methods (qualitative and quantitative) study of authorial identitiy and acedemic writing among dyslexic and non-dyslexic students.

This study was carried out with new lecturers on a two year Post Graduate Certificate in Learning and Teaching in Higher Education programme in a UK university. The aim was to establish their beliefs about how studying on the programme aligned with their teaching and learning philosophy and what, if anything, had changed or constrained those beliefs. Ten lecturers took part in an in‐depth semi‐structured interview. Content analysis of the transcripts suggested positive reactions to the programme but lecturers' new insights were sometimes constrained by departments and university bureaucracy, particularly in the area of assessment. The conflicting roles of research and teaching were also a major issue facing these new professionals.

Students with poorly developed authorial identity may be at risk of unintentional plagiarism. An instructional intervention designed specifically to improve authorial identity was delivered to 364 psychology students at three post‐1992 universities in London, UK, and evaluated with before‐and‐after measures of beliefs and attitudes about academic authorship, using the Student Authorship Questionnaire. Changes in questionnaire scores showed that the intervention led to significantly increased confidence in writing, understanding of authorship, knowledge to avoid plagiarism, and top‐down approaches to writing, and significantly decreased bottom‐up and pragmatic approaches to writing. For understanding of authorship, knowledge to avoid plagiarism and pragmatic approaches to writing, significant intervention by year of study interaction effects showed that the greatest improvements were among year one undergraduates. Direct evaluative feedback showed that 86% of students believed the intervention helped them avoid plagiarism and 66% believed it helped them write better assignments. Post‐intervention focus groups revealed changed student understandings about authorial identity and academic writing. The results show that interventions can help students avoid unintentional plagiarism by adopting more authorial roles in their academic writing. Further research could explore other influences on authorial identity, and examine the impact of authorial identity interventions on other outcome indicators.

This paper reports three studies about preparing Further Education (FE) students for the transition to Higher Education (HE) by improving their understanding of HE assessment criteria. In study 1, students and tutors in both FE and HE were interviewed for a qualitative analysis of their understandings and expectations about assessment criteria. In study 2, students in FE and HE completed questionnaires measuring self‐rated understanding and ability about assessment criteria, and beliefs about essay writing. Studies 1 and 2 both showed that FE students were more confident than HE students about their understanding and ability in relation to assessment criteria, but FE students' understandings suggested more surface approaches to learning and more naive epistemological beliefs. In study 3, a workshop intervention to improve FE students' understandings of HE assessment criteria was evaluated in a comparative longitudinal trial. The intervention reduced FE students' self‐rated understanding and ability, and p...

Many people with hemophilia are affected by chronic arthritic joint pain as well as acute bleeding pain. In this cross-sectional study, 209 men with hemophilia A or B completed the Hemophilia Pain Coping Questionnaire (HPCQ), the Chronic Pain Acceptance Questionnaire (CPAQ), and the RAND 36-item Health Survey (SF-36), a measure of health-related quality of life. Multiple regression was used to test the influence of active pain coping, passive adherence coping, and negative thoughts about pain (HPCQ scales), and activity engagement and pain willingness (CPAQ scales), on physical and mental components of quality of life (SF-36 PCS and MCS scales), taking account of age, hemophilia severity, use of clotting factor, and pain intensity. Pain intensity had the main influence on physical quality of life and negative thoughts had the main influence on mental quality of life. Activity engagement and pain willingness had small but significant influences on physical and mental quality of life. Pain willingness also moderated and partly mediated the influence of pain intensity on physical quality of life, and activity engagement and pain willingness mediated the influence of negative thoughts on mental quality of life. Negative thoughts moderated and partly mediated the influence of pain intensity on mental quality of life. There was no evidence that active pain coping influenced quality of life. The findings suggest that quality of life in hemophilia could potentially be improved by interventions to increase pain acceptance and reduce negative thoughts about pain.

Authorial identity is the sense a writer has of themselves as an author and the textual identity they construct in their writing. This article describes two studies exploring psychology students' authorial identity in academic writing. A qualitative focus group study with 19 students showed that authorial identity was largely unfamiliar to students, and highlighted the obstacles perceived by students to constructing authorial identities in university assignments. A questionnaire survey of 318 students explored the factor structure of an 18‐item Student Authorship Questionnaire. Three factors described aspects of student authorial identity (‘confidence in writing’, ‘understanding authorship’ and ‘knowledge to avoid plagiarism’), and three factors described approaches to writing (‘top‐down’, ‘bottom‐up’ and ‘pragmatic’). Confidence in writing and knowledge to avoid plagiarism were significantly higher among year 2 than year 1 students. Both studies could inform interventions to reduce unintentional plagiari...

Objectives Research is needed to enable more effective assessment and treatment of analgesic addiction among patients with painful chronic illnesses and to improve our understanding of the staff-patient interactions that give rise to pseudoaddiction. This study tested predictions that certain drug-use behaviors and pain-coping strategies were associated with analgesic addiction, and that certain were associated with risk of pseudoaddiction. Methods Analgesic addiction and risk of pseudoaddiction among patients with sickle cell disease were measured by symptom counts, using an interview method for classifying symptoms as pain-related (pseudoaddiction) or non-pain-related (analgesic addiction). Concern-raising drug-use behaviors and treatment requirements for pain were also assessed, and participants completed the pain-coping strategies questionnaire. Qualitative case descriptions of patients meeting criteria for analgesic addiction and pseudoaddiction were examined to identify common and distinctive features of the two groups. Results Consistent with predictions, multiple regression analyses showed that disputes about analgesics were independently associated with risk of pseudoaddiction. Physiological dependence and illicit drug use were both associated with analgesic addiction, independently of other factors. The qualitative data showed that analgesic addiction was not an obvious, clear-cut phenomenon: addiction and pseudoaddiction were superficially similar, and even symptoms of genuine addiction originated in patients' experiences of pain and illness. Conclusions These tentative findings were broadly consistent with what is known about analgesic addiction and pseudoaddiction in other painful conditions. They also suggested that current recommendations about addiction in pain patients could understate the potential importance of physiological dependence. The findings could inform staff training programs to improve pain management and reduce the incidence of pseudoaddiction. The classification of pain-related and non-pain-related symptoms could be used in further research on the development of analgesic addiction and the factors that influence staff attributions about addiction in patients with pain.

Judgments about people with pain are influenced by contextual factors that can lead to stigmatization of patients who present in certain ways. Misplaced staff perceptions of addiction may contribute to this, because certain pain behaviors superficially resemble symptoms of analgesic addiction. We used a vignette study to examine hospital staff judgments about patients with genuine symptoms of analgesic addiction and those with pain behaviors that merely resemble those symptoms. Nurses and doctors at hospitals in London, UK, judged the level of pain, the likelihood of addiction, and the analgesic needs of fictitious sickle cell disease patients. The patient descriptions included systematic variations to test the effects of genuine addiction, pain behaviors resembling addiction, and disputes with staff, which all significantly increased estimates of addiction likelihood and significantly decreased estimates of analgesic needs. Participants differentiated genuine addiction from pain behaviors resembling addiction when making judgments about addiction likelihood but not when making judgments about analgesic needs. The treatment by staff of certain pain behaviors as symptoms of analgesic addiction is therefore a likely contributory cause of inadequate or problematic hospital pain management. The findings also show what a complex task it is for hospital staff to make sensitive judgments that incorporate multiple aspects of patients and their pain. There are implications for staff training, patient education, and further research.

Psychological theory and research have contributed significantly to learning and teaching but have been less frequently applied to student assessment. This article reviews some of the ways in which psychology can be applied to the behaviours involved in assessment, from the formulation of assessment criteria to the reduction of biases and errors in marking. It is argued that one of the most important ways that psychology can contribute to assessment is by providing theory and methods to make implicit influences more explicit. The point is illustrated with examples of how personal construct theory has been used to develop grade descriptors and how judgement analysis has been used to investigate markers' decisions about students' work.

This paper describes the development and evaluation of a discipline-based skills module at Level 1 in the undergraduate psychology curriculum. The module combined generic and subject-specific skills teaching, linked skills provision with the personal tutor system and included practical exercises to promote deep learning and improve study skills. Student feedback showed that workshops and tutorials on essay writing were the most valued part of the module. The module assessment (a coursework essay about skills in higher education) was the part that most students asked to change. The response of psychology tutors was mixed and many tutors initially expressed misgivings about teaching generic skills. Following feedback from both students and tutors, the module developed to allow closer integration between generic skills and subject-specific teaching. Student progression across the psychology programme as a whole was not markedly higher after the introduction of the module by comparison with before, but other factors may also have affected student progression during that period. The module was designed to support student learning in psychology but, with adaptations of content, the approach of linking skills provision with subject-specific teaching and the personal tutor system could be applied in a range of other disciplines.

Pain is an important consequence of bleeding episodes in haemophilia. Previous research has included pain frequency and severity among measures of illness-related disability and quality of life in haemophilia, but little systematic evidence exists about analgesic use and pain coping in haemophilia. This paper reports cross-sectional findings from a national survey of patients with severe haemophilia type A and type B. Respondents provided information about pain frequency, pain coping strategies (using the haemophilia-adapted CSQ), use of analgesics and other drugs, and described any concerns they had about their drug use. Participants registered with comprehensive care haemophilia centres did not differ from the rest of the sample on any of the factors recorded. Over one-third of participants expressed concerns about their drug use, the most frequent of which were about dependence on prescribed analgesics. Pain frequency was the most important predictor of analgesic use, but pain coping, and specifically negative thoughts about pain, was associated with concerns about drug use independently of other factors, including analgesic use and pain frequency. Further research will be needed to evaluate possible interventions to promote more effective pain coping in haemophilia, and to examine the possible effects of pain coping on illness outcomes beyond analgesic use, such as well-being and quality of life.

Statistical combinations of specific measures have been shown to be superior to expert judgment in several fields. In this study, judgment analysis was applied to examination marking to investigate factors that influenced marks awarded and contributed to differences between first and second markers. Seven markers in psychology rated 551 examination answers on seven 'aspects' for which specific assessment criteria had been developed to support good practice in assessment. The aspects were: addressing the question, covering the area, understanding, evaluation, development of argument, structure and organization, and clarity. Principal-components analysis indicated one major factor and no more than two minor factors underlying the seven aspects. Aspect ratings were used to predict overall marks, using multiple regression to 'capture' the marking policies of individual markers. These varied from marker to marker in terms of the numbers of aspect ratings that made independent contributions to the prediction of overall marks and the extent to which aspect ratings explained the variance in overall marks. The number of independently predictive aspect ratings, and the amount of variance in overall marks explained by aspect ratings, were consistently higher for first markers (question setters) than for second markers. Co-markers' overall marks were then used as an external criterion to test the extent to which a simple model consisting of the sum of the aspect ratings improved on overall marks in the prediction of comarkers marks. The model significantly increased the variance in co-markers' marks accounted for, but only for second markers, who had not taught the material and had not set the question. Further research is needed to develop the criteria and especially to establish the reliability and validity of specific aspects of assessment. The present results support the view that, for second markers at least, combined measures of specific aspects of examination answers may help to improve the reliability of marking.

This article describes the development of assessment criteria for specific aspects of examination answers and coursework essays in psychology. The criteria sp cified the standards expected for seven aspects of students’ work: addressing the question, covering the area, understanding the material, evaluating the material, developing arguments, structure and organisation, and clarity in presentation. The criteria were designed to promote student learning, increase the reliability of marking, facilitate research on marking, and promote reflective practice among markers. Student feedback indicated that, despite being published in course materials, the impact of the criteria on students was much less than it could be, but the criteria supported other initiatives to promote student learning, including more structured feedback to students on coursework essays, and generic skills teaching on essay writing. The criteria were used in research to analyse the judgements made by markers of examination answers. That research revealed substantial individual differences among markers and more systematic differences between first and second markers. Some staff had reservations about specifying the assessment criteria in such detail, but the criteria provided a stimulus for staff reflection on the process of marking and agreeing marks. The development of the criteria opened up a number of avenues for further work on student learning and assessment and for further research on the psychology of marking.

We examined the psychiatric and forensic histories of 13 individuals whose first officially recorded criminal conviction took place after their 22nd birthday, and compared the levels of disturbance among that group with those from the same high-risk sample who had (a) no recorded convictions, (b) convictions only up to age 21, and (c) convictions before and after age 22. Among the 13 with recorded convictions only after age 22, there was evidence of at least minor juvenile delinquency in every case but one, and of major adult mental illness whose onset preceded first conviction in four cases. Levels of childhood antisocial behaviours were significantly higher among that group than among those who had never been convicted, and levels of major mental illness were significantly higher than among those who had never been convicted and those with convictions only up to age 21. Apparent late onset criminality in the present sample was therefore associated with known risk factors for adult criminality, in the form of juvenile antisocial behaviour and/or major mental illness. Officially recorded criminality consistently shows a small but significant number of individuals whose criminal activity appears to begin relatively late in life, that is after adolescence. In one large follow-up of unselected schoolchildren in Sweden, for example, 25 per cent of the males with a criminal record had their first conviction aged 21 or older. Among the females, 52 per cent of those with a criminal record had their first conviction at 21 or older (Stattin et al. 1989). The number of males with registered criminality only after age 21 (64 out of 709) was smaller by comparison with other groups of offenders than would be predicted from a random model (Stattin and Magnusson 1996), but still represented 9 per cent of the total male sample. In another unselected birth cohort of over 6,000 females born in Stockholm, Sweden in 1953, criminal records data revealed that 237 individuals had their first criminal registration after age 18. At 3.5 per cent of the total sample this was the largest group of offenders, compared with those who began offending before age 15 and persisted throughout life, those who offended only during adolescence, and those who offended in a less persistent way before and after age 18 (Kratzer and Hodgins 1996). Similar proportions with apparent late onset criminality have been found among groups who would be expected to be at higher risk for criminality, like clinic samples and those enrolled in social interventions. In McCord’s (1978) follow-up of 506 boys in the Cambridge-Somerville Youth Study, 41 of the 317 boys (13 per cent) with no official juvenile record of delinquency were convicted of serious crimes as adults, with few

Background Previous findings suggested that associations between childhood hyper-activity and later criminality were mediated mainly by conduct disorders. Method Information recorded in case notes was used to predict officially recorded criminal convictions in later life among 148 individuals who were seen as child psychiatric patients between 1948 and 1982. Multiple Poisson and logistic regressions were used to examine the independent contributions made by symptom/behaviour counts, diagnosed conduct disorder, and social and family factors to the prediction of recorded criminality during two later periods (ages 17–21 and 22+), taking into account previous recorded criminality in each case. Results Previous convictions were highly predictive of every offending outcome examined except convictions for violent offences. Among males, symptoms of hyper-activity were independently predictive of convictions at age 17–21, multiple offending (five or more separate convictions), and having received a custodial sentence. A childhood diagnosis of conduct disorder made little additional contribution to the prediction of later offending over and above the effects of previous convictions. Conclusion Symptoms of hyperactivity increased the risk of later convictions among boys with behavioural or emotional disturbances in ways that were not mediated by previous convictions or other measures of childhood conduct problems. Copyright © 2000 Whurr Publishers Ltd.

Joint pain related to haemophilia affects large numbers of people and has a significant impact on their quality of life. This article reviews evidence about behavioural and psychological aspects of joint pain in haemophilia, and considers that evidence in the context of research on other chronic pain conditions. The aim is to inform initiatives to improve pain self-management among people with haemophilia (PWH). Reduced pain intensity predicts better physical quality of life, so better pain management should lead to improved physical quality of life. Increased pain acceptance predicts better mental quality of life, so acceptance-based approaches to self-management could potentially be adapted for PWH. Pain self-management interventions could include elements designed to: improve assessment of pain; increase understanding of the difference between acute and chronic pain; improve adherence to clotting factor treatment; improve knowledge and understanding about the benefits and costs of using pain medications; improve judgements about what is excessive use of pain medication; increase motivation to self-manage pain; reduce negative emotional thinking about pain; and increase pain acceptance. The influence of behavioural and psychological factors related to pain are similar in haemophilia and other chronic pain conditions, so there should be scope for self-management approaches and interventions developed for other chronic pain conditions to be adapted for haemophilia, provided that careful account is taken of the need to respond promptly to acute bleeding pain by administering clotting factor.