Search

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.

In a western context, little is known about the term ‘gender disappointment’, which describes feelings of despair around not having a child of the desired sex. This study aimed to explore the lived experiences of British women who identify with the concept. Six mothers with only sons, who also desired a daughter, participated in a semi-structured interview via an online platform. An interpretative phenomenological analysis identified themes related to pity, societal expectations of unfulfillment, and concerns relating to the future mother-son relationship, feelings of guilt and shame, barriers to seeking help and the benefits of talking. The study concludes that there is a need for greater awareness of gender disappointment and the negative impact it has on maternal wellbeing. In addition, mothers who identify with gender disappointment would benefit from support from health visitors to enable them to access the help they need.

Background The Patient Safety Huddle (PSH) is a brief multidisciplinary daily meeting held to discuss threats to patient safety and actions to mitigate risk. Despite growing interest and application of huddles as a mechanism for improving safety, evidence of their impact remains limited. There is also variation in how huddles are conceived and implemented with insufficient focus on their fidelity (the extent to which delivered as planned) and potential ways in which they might influence outcomes. The Huddle Up for Safer Healthcare (HUSH) project attempted to scale up the implementation of patient safety huddles (PSHs) in five hospitals – 92 wards - across three UK NHS Trusts. This paper aims to assess their fidelity, time to embed, and impact on teamwork and safety culture. Methods A multi-method Developmental Evaluation was conducted. The Stages of Implementation Checklist (SIC) was used to determine time taken to embed PSHs. Observations were used to check embedded status and fidelity of PSH. A Teamwork and Safety Climate survey (TSC) was administered at two time-points: pre- and post-embedding. Changes in TSC scores were calculated for Trusts, job role and clinical speciality. Results Observations confirmed PSHs were embedded in 64 wards. Mean fidelity score was 4.9/9. PSHs frequently demonstrated a ‘fear free’ space while Statistical Process Control charts and historical harms were routinely omitted. Analysis showed a positive change for the majority (26/27) of TSC questions and the overall safety grade of the ward. Conclusions PSHs are feasible and effective for improving teamwork and safety culture, especially for nurses. PSH fidelity criteria may need adjusting to include factors deemed most useful by frontline staff. Future work should examine inter-disciplinary and role-based differences in TSC outcomes.

The double hermeneutic is a central feature of interpretative phenomenological analysis (IPA). Typically, this has been considered in relation to individual researchers working with experiential accounts from individual participants. IPA has, however, frequently been applied by multiple researchers; a further layer of complexity occurs when individual or multiple researchers analyse data from group interactions. Little attention has been paid to hermeneutic considerations in these contexts. We present insights into our encounters with multiple hermeneutics as well as our application of the hermeneutic circle; we also consider implications for IPA research. Our multi-vocal approach to analysis requires us to work in a much more integrative manner than is generally represented in IPA literature. Explicitly attending to multiple hermeneutics in focus group situations provides additional insights into the social and cultural contexts within which participants’ experiences exist. This article discusses how the inclusion of multiple hermeneutics adds richness and robustness to IPA.

The mental health benefits of physical activity and exercise are well-documented and asylum seekers who may have poor mental health could benefit from undertaking recommended levels of physical activity or exercise. Digital mobile applications are increasingly seen as feasible to precipitate behaviour change and could be a means to encourage asylum seekers to increase their levels of physical activity and exercise. This paper reports on a study that aimed to assess the feasibility of asylum seekers using the digital animation as a tool to change behaviour and increase their physical activity and exercise levels. A feasibility study underpinned by the principles of the COM-B behaviour change model was undertaken in West Yorkshire, UK, in 2019. Thirty participants were purposively recruited and interviewed. Peer interpreters were used as necessary. Deductive thematic analysis was undertaken to analyse the data. Overall, participants were positive about the feasibility of asylum seekers using the application as a behaviour change intervention. All expressed the view that it was easy to follow and would motivate them to increase their physical activity levels. Participants identified facilitators to this as the simplicity of the key messages, the cultural neutrality of the graphics and the availability of the mobile application in different languages. Identified barriers related to the dialect and accents in the translations and the over-simplicity of the application. This study has identified that a targeted digital animation intervention could help asylum seekers change their behaviour and hence improve their health and well-being. In designing such interventions, however, researchers must strongly consider co-design from an early stage as this is an important way to ensure that the development of an intervention is fit for purpose for different groups.

Background: A recent initiative in hospital settings is the patient safety huddle (PSH): a brief multidisciplinary meeting held to highlight patient safety issues and actions to mitigate identified risks. Aim: The authors studied eight ward teams that had sustained PSHs for over 2 years in order to identify key contributory factors. Methods: Unannounced observations of the PSH on eight acute wards in one UK hospital were undertaken. Interviews and focus groups were also conducted. These were recorded and transcribed for framework analysis. Findings: A range of factors contributes to the sustainability of the PSH including a high degree of belief and consensus in purpose, adaptability, determination, multidisciplinary team involvement, a non-judgemental space, committed leadership and consistent reward and celebration. Conclusion: The huddles studied have developed and been shaped over time through a process of trial and error, and persistence. Overall this study offers insights into the factors that contribute to this sustainability.

Teacher retention is a key issue facing schools, with stress, student behavior, current competitive policies, and practices resulting in many leaving within the first 5 years of qualification. Consequently, recent in-school research initiatives have focused on resilience training, although the quality of such conducted studies is debated. Drawn from compassion-focused therapy (CFT), this study set out to explore a six-module compassionate mind training (CMT) program with school staff to improve well-being. As part of their continued professional development, over 70 teachers and support staff took part in the CMT, with a mixed-measures AAB quantitative and qualitative design employed. This enabled us to explore both implementation effectiveness and outcome effectiveness in terms of parameters of well-being. The initiative was well received with the majority of staff reporting positively on their experiences of the curriculum and practices. Additionally, exercise practice was associated with significant increases in self-compassion (p < 0.01) and significant decreases in self-criticism (p < 0.05). Thematic analyses further revealed benefits of CMT for dealing with emotional difficulties. As a feasibility study, our results demonstrate many benefits of CMT in educational settings. CMT may hold promise as a way of helping those in education counteract the current competition-based nature of education, especially that which contributes to negative changes in well-being. Given this, future research should employ a control group design, a larger sample size, and a range of well-being measures at follow-up, to fully evaluate the utility of CMT in educational settings.

Traditionally, discourse analysis methodologies such as the Foucauldian discourse analysis have had a linguistic focus. However, apart from the discursive form, knowledge is also built into and transmitted through non-discursive means, such as actions and object materialisations. The dispositive is a heterogenous ensemble of speech, action and object materialisations, linked by a common thread of knowledge, acting as a single unit to fulfil a strategic function. The dispositive can be considered the operational building block of a discourse; dispositive analysis gives an insight into the mechanisms of discourse construction by social actors. No methodology has been developed yet to do a dispositive analysis. This paper explores the theoretical foundations of the dispositive and proposes a possible methodology. Dispositive analysis can be adopted by researchers who wish to study the mechanisms of discourse construction. Dispositive analysis can also provide a platform for researchers to do multi-method qualitative studies where the links between social constructions and individual experiences can be explored.

Background Many asylum seekers have complex mental health needs which can be exacerbated by the challenging circumstances in which they live and difficulties accessing health services. Regular moderate physical activity can improve mental health and would be a useful strategy to achieve this. Evidence suggests there are barriers to engaging black and minority ethnic groups in physical activity, but there is little research around asylum seekers to address the key barriers and facilitators in this group. Methods A two stage qualitative study used semi-structured interviews underpinned by the Theoretical Domains Framework. The interviews were conducted in voluntary sector groups in four towns/ cities in Northern England. Purposive sampling recruited 36 asylum seekers from 18 different countries. Interviews were audio recorded, transcribed verbatim and subject to framework analysis. Stage two involved a nominal group technique with five key stakeholders including asylum seekers and those that work with them. They followed a four stage process to rank and reach consensus on the key barrier to undertaking physical activity/ exercise that could be addressed locally through a future intervention. Results A number of barriers and facilitators were identified including a lack of understanding of the term physical activity and recommended levels but knowledge of the health benefits of physical activity/ exercise and the motivation to increase levels having engaged with activities back home. Living as an asylum seeker was considered a barrier due to the stress, poverty and temporary nature of living in an unfamiliar place. The outcome of the nominal group technique was that a lack of knowledge of facilities in the local area was the prevailing barrier that could be addressed. Conclusions Public health practitioners could develop interventions which capitalise on the motivation and knowledge of asylum seekers to encourage an increase in physical activity which may in turn reduce the breadth and depth of mental health needs of this group.

There is little qualitative research exploring non-cancer gynaecology patients’ experiences of enhanced recovery after surgery (ERAS) protocols. Seven women participated in audio-recorded interviews, discussing their experiences of enhanced recovery after surgery for gynaecological surgery. Data were transcribed and analysed using interpretative phenomenological analysis. Three themes were identified: meeting informational needs, taking control of pain, and mobilising when feeling fragile. Control emerged as a key element throughout the themes and was supported by provision of factual information. While participants were generally satisfied with their experience, topics such as concerns about analgesic use, the informal role of staff in mobilisation, and the expressed desire for more experiential information for participants require further research.

Most women do not reconstruct their breast(s) post-mastectomy. The experiences of younger women who maintain this decision, although important to understand, are largely absent in the research literature. This interview-based study uses interpretative phenomenological analysis to explore the experiences of six women, diagnosed with primary breast cancer in their 30s/40s, who decided against delayed reconstruction. Findings reported here focus on one superordinate theme (decision-making) from a larger analysis, illustrating that the women’s drive to survive clearly influenced their initial decision-making process. Their tenacity in maintaining their decision is highlighted, despite non-reconstruction sometimes being presented negatively by medical teams. Patient-centred support recommendations are made.

There is increasing interest in applying Interpretative Phenomenological Analysis (IPA) to focus group data, and in developing appropriate strategies for doing so. These strategies should exploit the unique features of focus groups, which provide a rich canvas of experiences not seen in individual interviews, while remaining true to the personal, phenomenological perspective of IPA. We present a four-stage approach with specific group focused analytical strategies: looking for ‘groupness’, clustering reoccurring group interactions, identifying interactional relationships, and incorporating group elements into an analysis. These stages are illustrated with worked examples developed while working with data from focus groups of women with gynaecological cancer discussing a yoga intervention, and explain how these can enrich our understanding of participants’ lived experiences. This approach demonstrates a suggested framework for developing IPA themes from focus group data by analysing and interpreting the group setting. We discuss links to psychological concepts, potential applications and limitations. This empirically based methodology is presented as a practical guide for other researchers grappling with this type of data.

There is increasing demand for work-based learning experiences to form part of undergraduate degrees concerned with working with people. Social justice and antioppressive practice underpin the philosophies of many such degrees, which attract students with the promise of working within diverse communities and with the marginalized and vulnerable. Benefits to students include the development of a professional identity, an antioppressive approach, and culturally competent practices. Despite this, critical approaches to work-based learning highlight ways in which the student can be colonized by dominant values via cultural voyeurism. This can lead to power inequalities being replicated and perpetuated by the student rather than challenged. The roles of identity and alterity in these learning processes are examined and the concept of professional identity is questioned. The article concludes that the tasks of negotiating identity and alterity are characterized by uncertainty and unfinalizability, and that the notion of cultural competence is itself problematic.

The development of a clear personal and professional identity—“knowing oneself”—is frequently cited as a key factor in supporting anti-oppressive practice. In the field of health and social care, work placements are a major vehicle for equipping students to become anti-oppressive practitioners committed to making effective diversity interventions in a range of organizational settings. This article highlights some of the tensions inherent in the formation of such an identity and pays particular attention to issues such as discomfort, power inequalities, the discursive production of the self, and ways in which educational and workplace organizational settings can simultaneously promote and inhibit such identity development. The article concludes that the discomfort experienced by students as part of this learning process is not only inevitable but necessary to becoming an anti-oppressive practitioner and that the narrative process offers ways of empowering both students and service users to challenge oppression.

Wansink and Sobal (2007) suggest that people make around 200 decisions every day about food, many of which are ‘mindless’. For young people control over any independent and conscious decisions about their food and eating might only happen after moving away from the family environment. The pilot study reported here outlines a thematic analysis investigating the experiences of four female university students regarding their eating behaviours in halls during their first year at university. Previous work has suggested that both eating disorders and weight gain are common within the student community (Bryant, Darkes & Rahal, 2012; LaCaille et al., 2011). Two main themes that were found throughout the analysis: the initial move from family life to independence and the flat environment. Participants explained the frustration they felt as several factors restricted them in their ability to apply their knowledge about food to their eating behaviours. The conclusions suggest how psychology might further explore ways in which the eating behaviours of students might be improved.

The development of intercultural competence in higher education students is widely seen as desirable yet the processes involved in this development are not fully understood. This chapter sets out the position that the development of intercultural competence in students is dependent upon their undergoing some shift in their identity by actively engaging in ‘transformative learning'. Focusing on the UK context, the authors contend that this transformational process is fraught with challenges and involves several key psychological and interpersonal factors which are not widely acknowledged (including positioning, cultural voyeurism and repressive tolerance). These can involve acute discomfort for the student as s/he develops a critical awareness of power relations and of their place within them. The chapter concludes that ongoing dialogue and dispute in the context of criticality embedded in the curriculum are necessary to support the student in this transformative learning experience.

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: Longer consultations in primary care have been linked with better quality of care and improved health-related outcomes. However, there is little evidence of any potential association between consultation length and patient experience. AIM: To examine the relationship between consultation length and patient-reported communication, trust and confidence in the doctor, and overall satisfaction. DESIGN AND SETTING: Analysis of 440 videorecorded consultations and associated patient experience questionnaires from 13 primary care practices in England. METHOD: Patients attending a face-to-face consultation with participating GPs consented to having their consultations videoed and completed a questionnaire. Consultation length was calculated from the videorecording. Linear regression (adjusting for patient and doctor demographics) was used to investigate associations between patient experience (overall communication, trust and confidence, and overall satisfaction) and consultation length. RESULTS: There was no evidence that consultation length was associated with any of the three measures of patient experience (P >0.3 for all). Adjusted changes on a 0-100 scale per additional minute of consultation were: communication score 0.02 (95% confidence interval [CI] = -0.20 to 0.25), trust and confidence in the doctor 0.07 (95% CI = -0.27 to 0.41), and satisfaction -0.14 (95% CI = -0.46 to 0.18). CONCLUSION: The authors found no association between patient experience measures of communication and consultation length, and patients may sometimes report good experiences from very short consultations. However, longer consultations may be required to achieve clinical effectiveness and patient safety: aspects also important for achieving high quality of care. Future research should continue to study the benefits of longer consultations, particularly for patients with complex multiple conditions.

Accessible summary • This study reports on a small collaborative research project started by service users, and on a subject chosen by them, and then carried out with staff from a local NHS Trust and University. • It looks at the choices people make in changing or stopping mental health medications, and their experiences of how professional staffs were either helpful or unhelpful in advising and helping them with these choices. Some of the themes generated in the focus groups are examined in detail and recommendations made for practice including the need for better information giving to support choice. • The themes examined include ‘the two faces of service provision’ which looks at positive and less positive experiences of service provision, the general practice/mental health divide which points out differences and difficulties between general practice and specialist practice, and ‘becoming an informed service user’ which examines the many sources of information available to service users and how they use these. Abstract This paper reports on a collaborative research project initiated by service user representatives and led by clinicians from the mental health service in Derbyshire. The study explored the experiences of mental health service users when they either changed or terminated their use of mental health-related medications. Three focus groups were conducted with mental health service users from across the county. An inductive thematic analysis identified six key themes, three of which are reported here: the ‘two faces’ of service provision, describing the positive and negative experiences of services; the general practice/mental health divide, relating to the lack of continuity between the two services; and becoming an informed service user, where participants discussed the importance of seeking information. It is important that mental health professionals always consider presenting their ‘best face’ to service users, and facilitate the prescribing process with general practitioners. The findings also highlight the potential for supporting service users in using different sources of information to become more informed about medication.

People make sense of their lives through their narratives, which provide a set of culturally shared plots that give their lives meaning and represent belonging. A range of personal and cultural experiences is made available through analysing these narratives. Here, analysis of men's personal narratives is considered as a valuable means by which the culture of men's friendship can be explored and defined. We present a method for generating narratives, where respondents were asked in an online survey to describe a deep connection or fall-out with a friend. One of these written narratives is analysed here by adapting Labov's framework for analysing narrative in conversation and supplementing it with insights from discursive work.

This study investigated how a Greek gay man experienced his homosexuality over the course of his life, while living in Greece. Research has shown that sexuality does not play an important role in variables such as intimacy, and love (Elizur - Mintzer, 2003; Wagner, Remien - Carballo-Dieguez, 2000). Social and cultural parameters however affect sexuality acceptance and psychological wellbeing (Bader, 2009; Wight, LeBlanc - Lee Badgett, 2013). In the Greek society many gay men over the years chose to conceal their sexual identity out of fear of harassment (Veremis et al, 2013). Greece however has just passed a new same-sex union law aiming at giving equal rights to homosexual couples. This study based on a single interview case, aimed at interpreting the participant’s reality under the premises of Interpretative phenomenological analysis. The participant, a 42 year old gay man, participated in an one hour semi-structured interview. Four themes emerged as a result of the transcript analysis; the need to be normal; time as a construct in his life; the importance of micro and macro environment; dealing with feelings and emotions. The participant’s need for safety and comfort, the emotional implication from lack of it, as well as his positive emotions as a result of intimacy, love and wide acceptance have emerged from the analysis of the theme “dealing with feelings and emotions”. The findings of the analysis are supported by existing literature. The nature of this qualitative study has helped the researcher to give voice to the participant and to analyze his experiences and concerns from a psychological perspective (Larkin, Watts, - Clifton, 2006).

To explore patients' experiences of taking part in a yoga intervention while undergoing treatment for gynaecological cancer.Sixteen women (age range 31-79 years; mean age 60) participated in focus groups based on a semi-structured question schedule. Resulting discussions were audio-recorded, transcribed verbatim and analysed using interpretative phenomenological analysis (IPA).Royal Derby Hospital, UK.Patients took part in a 10-week course of Hatha yoga, where they participated in a one hour long class per week.Three themes emerged from the data: applying breathing techniques, engaging in the physicality of yoga and finding a community. The first theme was particularly important to the patients as they noted the breadth and applicability of the techniques in their day-to-day lives. The latter two themes reflect physical and social perspectives, which are established topics in the cancer and yoga literature and are contextualised here within the women's experiences of cancer treatment.The women's perceptions of the programme were generally positive, providing a previously unseen view of the patient experience of participating in a yoga intervention. The difference between the women's prior expectations and lived experiences is discussed.

This article seeks to explore autobiographically women’s friendship in the gendered workplace. Within Western culture friendship is seen as being appropriately located within the private arena (O’Connor, 1992) . The article focuses on the implications for both friendship and work relationships when this “public/private” boundary is blurred. We argue that despite some negative consequences women’s friendships in the gendered workplace can nevertheless be seen as acts of resistance.

This study investigated how men and women made sense of multiple goals during fertility treatment. Both members of three heterosexual couples participated in two or three semi-structured interviews over 6 months, producing 14 accounts, which were analysed using interpretative phenomenological analysis. The goal of biological parenthood dominates assumptions in infertility research, but its importance varied between participants, who balanced that goal with retaining emotional well-being, avoiding financial difficulties and maintaining their relationship. These themes are discussed in the context of the self-regulation model, which allows fertility treatment experiences to be conceptualised more broadly than do other models.

This article maps the components of telephone tutorial conferences (TTCs) used for distance learning in higher education. Using conversation analysis we identified four common sequences of TTCs as `calling in'; `agenda-setting'; `tutorial proper'; and `closing down'. Patterns of student participation look similar to those in face-to-face tutorials and the degree of interaction during `calling-in' and agenda setting does not foretell student participation in the `tutorial proper'. Student participation was related to differences in `communicative formats' adopted by tutors and students for different purposes. These findings have helped us reflect on our communicative practices as university teachers and indicate that TTCs are functionally comparable with face-to-face tutorials in higher education settings.

7–9 September 2010, University of Winchester.